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Health Care Management – Part 1 14Mar2009

HCM #1 & 2 – Cost, Quality, and Access to Health Care I & II


1) Which of the following statements is NOT true (in the United States)?
a) Health insurance is tightly linked to employment
b) Drug mistakes injure 500,000 a year
c) Infections caught in hospitals kill 90,000 people per year
d) The uninsured population is at 47 million (2006)
2) With an ever-advancing technology-driven medical delivery system, we should:
a) Focus on high-technology over low-technology
b) Focus on low-technology over high-technology
c) Consider high-technology at any cost to save lives
d) Consider low-technology at any cost to save lives
e) Strive for a balanced investment in high- and low-technology
3) Per capita health care spending (international dollar) is the highest in:
a) Japan
b) Luxembourg
c) United States
d) Germany
e) Cuba
4) Which of the following is NOT a characteristic of imperfect market conditions in
United States health care?
a) Decisions are often determined by need, rather than price-based demand
b) Patients do not directly bear the cost of services (moral hazard)
c) Patients are not always well-informed about care that is needed, and cost of that
care
d) Growth of a single giant medical system improves competition
5) Market justice says medical care and its benefits are based on willingness and ability
to pay. These conditions prevail over social justice, which emphasizes the well-being of
the community over that of the individual.
a) True
b) False
6) Using resources sensibly and preventative medicine (safeguarding personal health) is
the accountability role of the:
a) Physician
b) Patient
c) Government
d) Employers
e) Insurance companies
7) Why is United States health care NOT delivered in a true free market?
a) Unrestrained competition occurs
b) Patients are always well-informed
c) Patients directly bear cost of service
d) Decisions are based on need rather than price-based demand
8) In 2005, how much was spent on health care in the United States?
a) $2 million
b) $1 billion
c) $2 billion

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d) $1 trillion
e) $2 trillion
9) Which of the following is NOT a key factor in the increasing cost of health care?
a) Growth of technology
b) Increase in elderly population
c) Preventative medicine
d) Third-party payment
e) Defensive medicine
10) Which of the following statements is NOT true?
a) Rapid expansion of specialty facilities drives costs higher
b) Continuing rise in obesity in U.S. drives costs higher
c) Increased patient cost-sharing drives costs higher
d) Blockbuster drugs losing patent protection drives costs lower
11) The average annual cost for family health coverage in 2007 in the United States is
more than:
a) $10,000
b) $11,000
c) $12,000
d) $13,000
e) $14,000
12) What percentage of adults in middle-income families have difficulty affording their
health insurance?
a) 50%
b) 30%
c) 70%
d) 10%
e) 90%
13) General Motors pays (slightly) more for steel than for health care costs.
a) True
b) False
14) What will be a consequence of switching from managed care to consumer-driven
health plans?
a) Employees are given a flexible amount of money to pay
b) It will educate consumers about speculative quality issues
c) Employees will not have flexibility in coverage
d) Auditors will interfere with clinical decisions
e) Greater transparency
15) In the United States in 2006, how many Americans were uninsured?
a) 27 million
b) 37 million
c) 47 million
d) 57 million
e) 67 million
16) How many people are injured from drug mistakes annually?
a) 500,000
b) 1 million

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c) 1.5 million
d) 2 million
e) 2.5 million
17) What is the eligibility age for government Medicaid coverage?
a) 45
b) 55
c) 65
d) 75
e) No specific age
18) Government insurance for low-income individuals is available for all of the following
EXCEPT:
a) Children
b) Parents
c) Pregnant women
d) Refugees
e) Individuals with disabilities
19) Which of the following is NOT true regarding the uninsured?
a) Children account for 80% of the uninsured
b) Poor have the greatest risk of being uninsured
c) Those with less education are more likely to be uninsured longer
d) Over 8 in 10 come from working families
20) Postponing needed care, inability to fill a prescription, inability to follow a treatment
plan, and not seeking preventive care are characteristics of:
a) Elderly
b) Uninsured
c) Children
d) Working adults
e) Teenagers
21) California’s Plan (2007) was to provide ____ coverage to all residents.
a) Complete
b) Social
c) Incremental
d) Universal
e) Costly
22) Medical errors in the United States result in approximately how many deaths
annually?
a) 440-980
b) 4,400-9,800
c) 44,000-98,000
d) 440,000-980,000
e) 4,400,000-9,800,000
23) Hospital-acquired infections are less costly to the health care system and associated
with a lower mortality rate when compared to non-hospital-acquired infections.
a) True
b) False

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24) Which of the following is NOT one of the three best practices (from CDC and
AHRQ) to provide the greatest health benefit?
a) Discussing diet and exercise
b) Discussing daily aspirin use with at-risk adults to prevent cardiovascular
disease
c) Immunizing children
d) Intervening with smokers to help them quit
25) The Dartmouth Atlas Project looked at:
a) Health care cost comparisons
b) Differences in patient populations
c) Likelihood of a patient with chronic illness to be in an academic center
d) Changes in chronic disease
e) Variations in care received
26) Walk-in clinics, which treat common ailments, administer vaccines, do screenings,
and prescribe drugs, are often staffed by:
a) Licensed practical nurses (LPNs)
b) Registered nurses (RNs)
c) Nurse practitioners (NPs)
d) Physicians (MDs/DOs)
e) Nursing assistants (NAs)
27) Which of the following can be considered a negative effect of Pay-For-Performance
health care?
a) Measurement drives improvement
b) Decreases inappropriate variation in care
c) Offers financial incentives
d) Results in “cherry picking” healthy patients
e) Ties compensation to performance

HCM #3 – Current Health Care Issues I: To Err Is Human


1) Which of the following has the highest annual mortality rate?
a) AIDS
b) Breast cancer
c) Motor-vehicle crashes
d) Preventable medical errors
2) High error rates with serious consequences are most likely to occur in all of the
following places EXCEPT:
a) Intensive care units
b) Emergency departments
c) Operating rooms
d) Radiology departments
3) Medical errors have been estimated to result in total costs between ____ and ____
annually.
a) $17,000; $29,000
b) $17 million; $29 million
c) $17 billion; $29 billion
d) $17 trillion; $29 trillion

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Health Care Management – Part 1 14Mar2009

4) Types of errors include all of the following EXCEPT:


a) Collaboration
b) Diagnostic
c) Treatment
d) Preventive
e) Communication
5) All of the following are recommended approaches to improvement from the 1999
Institute of Medicine (IOM) report “To Err is Human: Building a Safer Health System”
EXCEPT:
a) Establishing a national focus to create leadership, research, tools, and protocols
to enhance the knowledge base about safety
b) Focusing on key clinical situations including the administration of insulin,
reducing bed sores, preventing hospital-acquired infection, and hand washing
c) Identifying and learning from errors by developing a nationwide public
mandatory reporting system and by encouraging health care organizations and
practitioners to develop and participate in voluntary reporting systems
d) Raising performance standards and expectations for improvements in safety
through the actions of oversight organizations, professional groups, and group
purchasers of health care
e) Implementing safety systems in health care organizations to ensure safe
practices at the delivery level
6) Efforts by the Agency for Healthcare Research and Quality (AHRQ) to develop and
implement an action plan (in response to the 1999 IOM report) included all of the
following EXCEPT:
a) Developing and testing new technologies to reduce medical errors
b) Funding researchers and organizations to develop, demonstrate, and evaluate
new approaches to improving provider education in order to reduce errors
c) Conducting large-scale demonstration projects to test safety interventions and
error-reporting strategies
d) Supporting projects aimed at achieving a better understanding of how the
environment in which care is provided affects the ability of providers to improve
safety
e) Funding government insurance (Medicare/Medicaid) to not pay physicians
when mistakes are made and not allow hospitals to charge patients for mistakes
7) All of the following organizations were involved in improvement efforts after the 1999
IOM report EXCEPT:
a) Council on Graduate Medical Education (COGME)
b) National Advisory Council on Nurse Education and Practice (NACNEP)
c) National Academy for State Health Policy (NASHP)
d) The Delta Group
e) The Leapfrog Group

HCM #4 – Current Health Care Issues II: Crossing the Quality Chasm
1) Which of the following is NOT a factor contributing to the disparity between current
health care in the United States and the quality it could achieve?
a) Unprecedented advances in medical science
b) Unprecedented advances in technology

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c) Growing complexity of health care


d) The number of patients being seen has drastically increased
2) What percentage of patients with chronic conditions have more than one chronic
condition?
a) 20%
b) 40%
c) 60%
d) 80%
e) 100%
3) Which of the following is NOT a factor for making a change possible in the health
care system?
a) Supportive payment and regulatory environment
b) Organizations that facilitate the work of patient-centered teams
c) Making incremental improvements to the current system
d) High performing patient-centered teams
4) All of the following are aims for health care improvement EXCEPT:
a) Safe
b) Equitable
c) Personalized
d) Competent
e) Effective
5) What describes providing care that does NOT vary in quality because of personal
characteristics such as gender, ethnicity, geographic location, and socioeconomic status?
a) Patient-centered
b) Efficient
c) Effective
d) Costly
e) Equitable
6) Which of the following is NOT a rule for redesign of the health care system, according
to the 2001 IOM report?
a) The health care providers and facilities are the source of control
b) Care is based on continuous healing relationships
c) Care is customized according to the patient needs and values
d) Knowledge is shared and information flows freely
e) Decision making is evidence-based
7) Which of the following was NOT a rule for redesign of the health care system,
according to the 2001 IOM report?
a) Safety is a system property
b) Transparency is necessary
c) Needs are anticipated
d) Efficiency is continuously decreased
e) Cooperation among clinicians is a priority
8) Redesigning the health care delivery system required changing the structures and
processes of the environment in which health professionals and organizations functioned.
Changes needed to occur in all of the following areas EXCEPT:
a) Applying evidence to health care delivery
b) Applying cost-saving experimental procedures

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c) Using information technology


d) Aligning payment policies with quality improvement
e) Preparing the workforce

HCM #5 – Current Health Care Issues III: Preventing Medication Errors


1) According to the 2006 IOM report, in any given week how many United States adults
will use prescription medicines, over-the-counter drugs, or dietary supplements?
a) 1/5
b) 2/5
c) 3/5
d) 4/5
e) All
2) In any given week, how many United States adults will take five or more different
medications?
a) 1/2
b) 1/3
c) 1/4
d) 1/5
e) 1/6
3) On average for a hospital patient, how many medication errors can be expected?
a) Once per month
b) Once per week
c) Every three days
d) Every other day
e) Every day
4) According to the 2006 IOM report, one of the most effective ways to reduce
medication errors is to move toward a model of health care where there is more of a
partnership between the patients and the health care providers.
a) True
b) False
5) All of the following are benefits of technology use for prescribing medication
EXCEPT:
a) Reducing hand-off errors
b) Reducing drug-allergy errors
c) Reducing dependence on technology
d) Reducing overly high dosage errors
e) Reducing drug-drug interaction errors
6) What type of error is being addressed when the drug industry was asked to improve
drug names, nomenclature, abbreviations, and acronyms?
a) Handwritten prescription errors
b) Packaging (pill bottle) errors
c) Labeling errors
d) Over-prescription errors
e) Side-effect errors

HCM #6 & 7 – Physician Compliance I & II

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1) All of the following are Health Information Portability and Accountability Act
(HIPAA) regulation sets EXCEPT:
a) Privacy regulations
b) Security regulations
c) Identity regulations
d) Transactions and code sets
2) A Physician Compliance Plan is designed to:
a) Limit the number of Medicare and Medicaid patients seen by providers
b) Maximize revenue for all participating providers
c) Strengthen the physician practice
d) Prevent the submission of erroneous claims or engaging in unlawful conduct
involving Federal health care programs
e) Ensure all Medicaid patients have access to primary care providers
3) Which of the following is NOT a historical example of managing compliance?
a) Consent decrees under antitrust laws
b) Decrees on medical device manufacturers by the Food and Drug
Administration
c) Closing agreements imposed by the Internal Revenue Service
d) Self-auditing encouraged by the Environmental Protection Agency
e) Maximizing profit through hidden accounting procedures by Enron
4) In the past, some Compliance Plans contained ____ elements as ordered by judges
after prosecution and conviction. This held the entity to a higher standard prospectively
than was required by law, or than was required of other persons or entities in the same
industry.
a) Punitive
b) Compensory
c) Statutory
d) Nominal
e) Tort
5) Prior to the mid-1990s, experience with Compliance Plans in the health care sector
was largely limited to large ____ held corporations that had been investigated for
Medicare and Medicaid fraud.
a) For-profit privately
b) For-profit publicly
c) Non-profit privately
d) Non-profit publicly
6) After the 1995 Physicians at Teaching Hospitals (PATH) investigations began, the
University of Pittsburg Medical Center (UPMC) was one of the first to be looked at. They
executed a ____ in response to the erroneous billing and other non-compliance. This type
of contract with the government usually last ____ years.
a) Formal compliance plan; 1
b) Formal compliance plan; 5
c) Corporate integrity agreement; 1
d) Corporate integrity agreement; 5
e) RAT STAT; 10

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Health Care Management – Part 1 14Mar2009

7) If a physician is under a corporate integrity agreement and leaves the hospital under
agreement to work at a new hospital, they no longer need to worry about being audited.
a) True
b) False
8) When did the Office of Inspector General (OIG) release the first formal guidance that
addressed physician group practices, called “Compliance Guidance for Individual and
Small Group Physician Practices”?
a) 1970
b) 1990
c) 1995
d) 2000
e) 2005
9) There is NO universally applicable federal statutory or regulatory requirement that all
group practices develop and maintain internal compliance plans or programs.
a) True
b) False
10) The OIG has developed enforcement policies that favor organizations that have
previously developed voluntary compliance programs.
a) True
b) False
11) Which of the following is a risk of non-compliance for the physician?
a) Can be excluded from government programs
b) Can be assessed civil money penalties
c) Can be taken to court
d) Can lose their license to practice medicine
e) All of the above
12) Which of the following is NOT a core element of a Compliance Plan?
a) Auditing and monitoring
b) Establishing practice standards and procedures
c) Developing one-way communication
d) Conducting appropriate training and education
e) Responding to detected offences and developing corrective action initiatives
13) Who is responsible for bills submitted by midlevel providers (PA, NP) in your
clinical practice?
a) The midlevel provider
b) The administrative assistant
c) The billing specialist
d) Whoever is responsible for the number they billed under
e) The government
14) Reviewing the accuracy and completeness of internal documentation, coding, and
billing records is an example of what Compliance Plan element?
a) Establishing practice standards and procedures
b) Auditing and monitoring
c) Responding to detected offences and developing corrective action initiatives
d) Enforcement
e) Conducting appropriate training and education

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15) The best choice for designating a Compliance Officer would be to choose:
a) Yourself
b) The billing specialist
c) Another physician
d) The clinician who bills the most
e) Someone who does not deal with internal billing practices
16) A reporting system must be established to allow employees or physicians to report
perceived compliance problems. The system should ensure they feel comfortable
reporting ____.
a) Electronically
b) Easily
c) Anywhere
d) Anytime
e) Without retribution
17) Which of the following does NOT pertain to the Compliance Plan element of
Enforcement?
a) Annual training in coding and billing
b) Making prompt refunds when clear overpayments are made
c) Referring very noncompliant employees to law enforcement authorities
d) Most compliance plans use graduated enforcement techniques
e) Enforcement adds credibility and integrity to a compliance plan
18) You are working as a physician in a thirty-physician multi-specialty group that is self
owned. A new business office manager finds a significant number of overpayments to
Medicare, Medicaid, and commercial insurance companies. Which of the following is the
most likely to occur?
a) Medicare will discover the errors
b) Medicaid will discover the errors
c) A commercial insurance company will discover the errors
d) Someone within your practice will tell the insurance carriers
e) Nothing will happen if billing is corrected from that point onward

HCM #8 & 9 – Malpractice I & II


1) Medical malpractice is a deviation from the accepted medical standard of care and
must also:
a) Be illegal
b) Anger the patient
c) Be completely wrong
d) Injure the patient
e) Involve auxiliary staff
2) Standard of care is determined by all of the following EXCEPT:
a) Literature
b) Paid experts
c) Medicare/Medicaid officials
d) National perspective
3) Legal duty, breach of duty, and causation are elements needed for what type of legal
case?

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a) Medical malpractice
b) Negligence
c) Abandonment
d) Battery
e) Manslaughter
4) Pain, suffering, embarrassment, and mental anguish are examples of what type of
damage or injury?
a) Non-Economic
b) Economic
c) Punitive
d) Legal
e) Medical
5) What type of damages are NOT, by law, covered by any malpractice insurance carrier
and are meant to prevent a wrong action from occurring again?
a) Non-Economic
b) Economic
c) Punitive
d) Legal
e) Medical
6) A document served by a Sheriff, Constable, or other process server that contains the
allegations of negligence against you is called a(n):
a) Summons
b) Interrogatory
c) Deposition
d) Warrant
e) Complaint
7) Notification that a lawsuit has been filed (without listing allegations) is called a(n):
a) Summons
b) Interrogatory
c) Deposition
d) Warrant
e) Complaint
8) Oral questions of the other party witness done under oath is called a(n):
a) Summons
b) Interrogatory
c) Deposition
d) Allegation
e) Board
9) Based on the Statute of Limitations and considering minors, patient documentation
should be kept for a minimum of ____ years to ensure it will be available to the physician
if a medical malpractice (negligence) claim arises.
a) 2
b) 5
c) 7
d) 18
e) 20

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10) Claim for a medical malpractice does not arise until the patient knows (or should
have known) of the malpractice and its cause of injury. This is called the:
a) Statute of limitations
b) Discovery rule
c) Waiting period
d) Designated timeframe
e) Legal window
11) All of the following must be discussed to have informed consent from the patient
prior to an invasive procedure (surgery) EXCEPT:
a) Special devices being used in the procedure
b) Risks of the procedure
c) Complications of the procedure
d) Alternatives to the procedure
12) All of the following are reasons why a patient may sue a physician EXCEPT:
a) Unreasonable expectations
b) Poor understanding, communication, or rapport with the physician
c) Money
d) Media
e) To double the physician’s penalties via a second lawsuit (double jeopardy)
13) All of the following are reasons why a patient may sue a physician EXCEPT:
a) Someone told them to
b) Death
c) A bad result or outcome
d) Grief (someone must be at fault)
e) Litigious society/lawyers
14) All of the following are beneficial for the patient and physician EXCEPT:
a) Informing the patient what to expect, what you are doing, and what you find
b) Discussing a treatment plan
c) Allowing missed appointments without documenting them
d) Allowing a patient to vent privately and demonstrating that you care about the
patient and the situation
e) Avoiding blame assignment
15) Documentation is essential for providing proof of procedures, treatments, and finding
if a physician is taken to court.
a) True
b) False
16) All of the following are aspects of current (2007) tort reform EXCEPT:
a) Earning capacity reduced to present value
b) Productivity and inflation allowed
c) Future medical and related costs paid as a lump sum, not periodically
d) Payments cease upon death
e) Caps on economic and non-economic damages
17) Punitive damages can be assessed in all of the following situations EXCEPT:
a) Willful or wanton conduct
b) Intentional act such as breaking informed consent
c) Wrong organ cases

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d) Reckless indifference to patient’s rights


e) A major, debilitating procedural complication occurs and was explained in the
informed consent document
18) On average, how often can a physician expect to be sued?
a) Every month
b) Every year
c) Every five years
d) Every ten years
e) Every fifteen years

HCM #10 – Current Health Care Issues IV: Retail Health Clinics
1) Retail health clinics are usually staffed by what type of medical providers?
a) Paramedics
b) Midlevel (PA, NP)
c) Physicians
d) Technicians
e) Nursing Assistants
2) Which of the following is NOT a benefit of retail health clinics?
a) Convenient hours
b) Convenient locations
c) Personal nature as they know your medical history
d) Affordability
e) Ability to treat common acute ailments
3) There are currently (2007) about a dozen retail health companies nationally. The
industry is growing:
a) At 75 clinics per year
b) At 300 clinics per year
c) At 1,400 clinics per year
d) At 1,775 clinics per year
e) Too rapidly to allow for an exact count
4) An October 2005 Public Opinion Strategies poll indicated that approximately what
percentage of adults would be likely to use a retail health clinic?
a) 100%
b) 60%
c) 20%
d) 10%
e) 0%
5) An October 2005 Wall Street Journal poll on those who had used a retail clinic
indicated they had ____ satisfaction in the areas of convenience, quality of care, staff’s
qualifications, and cost.
a) 80-100%
b) 60-80%
c) 40-60%
d) 20-40%
e) 0-20%

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6) An October 2005 Wall Street Journal poll indicated that ____ said they would be
worried that serious medical problems might be misdiagnosed at a retail health clinic.
a) 5%
b) 10%
c) 25%
d) 75%
e) 100%
7) Insurance companies are beginning to contract with retail clinics, allowing patients to
pay just their ____ when they use a retail clinic and in some cases having their ____
waived completely.
a) Expenses
b) Bill
c) Co-pay
d) X-rays
e) Blood tests
8) In late 2005, the Academic Academy of Family Physicians (AAFP) released a Desired
Attributes guideline for retail health clinics. It included: evidence-based medicine, team-
based approach, referrals, and electronic health records (EHRs). The goal of this
document was to set a standard for:
a) Pricing for patients
b) Payments to insurance companies
c) Expectations of patient load, geographically
d) Geographic location
e) Quality and safety
9) The AAFP’s Retail Medicine Workgroup has talked to retail health companies about:
a) Having AAFP physicians working at retail health clinics
b) Having AAFP-produced patient-education materials available
c) Closing down retail health clinics
d) Adding radiographic diagnostics to retail health clinics
e) Allowing childbirth to take place at retail health clinics
10) Family practice physicians have which of the following concern regarding the rise of
retail health clinics?
a) They will lose their patients
b) They will lose some revenue
c) Important preventative care will not occur
d) Bigger medical problems may go undetected
e) All of the above
11) Which of the following could NOT be considered a benefit of retail health clinics?
a) They provide an entry point into the health system for those without primary
care physicians
b) They can care for the underrepresented and uninsured due to lower costs and
convenience
c) They can lead to missed ailments that clinic providers are not trained to find
d) Family physicians will take less call as retail health clinics are open during
regular call hours (nights, weekends, holidays)
e) They will take away some of the burden from Emergency Departments

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12) Getting on a retail clinic’s referral list or looking into becoming a clinic’s supervising
physician are examples of:
a) Cooperation
b) Competition
c) Business
d) Legal
e) Medicine
13) Which of the following is NOT an example of ways for physicians to be more
competitive with retail clinics, from the patient’s point of view?
a) Spread the word about your clinic
b) Write letters to patients who visit a retail health clinic
c) Keep your nurse practitioners happy so they don’t leave
d) Wait is out as patients will need to see a doctor eventually
e) Be innovative or buy your own clinic

HCM #11 & 12 – Current Health Care Issues V & VI: The Uninsured
1) In 2005, most Americans under the age of 65 received health insurance coverage:
a) As an employer benefit
b) By paying though smaller insurance companies
c) By paying though larger insurance companies
d) Though their spouse
e) By paying as they go
2) If the United States non-elderly population in 2005 was about 230 million people,
what percentage would have been uninsured?
a) 100%
b) 80%
c) 60%
d) 40%
e) 20%
3) Which of the following is NOT true regarding private health insurance coverage?
a) Many, but not all, employers offer group health insurance policies to their
employees as a benefit and also often extend coverage to their employees'
families
b) Employer-sponsored health insurance is voluntary; businesses are not legally
required to offer health benefits, and employees can choose not to participate
c) The Medicaid program provides coverage to all of the low-income and disabled
uninsured
d) Private policies directly purchased in the non-group market (i.e., outside of
employer-sponsored benefits) cover only 5% of non-elderly Americans
e) Private health insurance coverage is subsidized through the federal tax system
in several ways
4) Medicaid and the State Children’s Health Insurance Program (SCHIP) covered ____ of
all children and ____ of low-income children, in 2005.
a) 1/2; 1/4
b) 1/4; 1/2
c) 1/2; 1/2

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d) All; 1/2
e) 1/2; All
5) How many people with severe disabilities did Medicaid cover in 2005?
a) All
b) 1 in 2
c) 1 in 3
d) 1 in 4
e) 1 in 5
6) In 2005, how many of the uninsured came from working families?
a) All
b) 8 in 10
c) 6 in 10
d) 4 in 10
e) 2 in 10
7) Which of the following is NOT true regarding health insurance in 2005?
a) Because of the high cost of health insurance, the poor and near-poor have the
greatest risk of being uninsured
b) Adults are more likely to be uninsured than children
c) More than 60% of non-elderly uninsured adults did not attend college, making
them less able to get higher-skilled jobs that more typically provide health
coverage
d) Most of the uninsured that came from working families only worked part-time
e) Minorities are much more likely to be uninsured than white Americans
8) Which of the following is NOT true regarding health insurance in 2005?
a) The large majority of the uninsured are native or naturalized U.S. citizens
b) The majority (85%) of adults over the age of 65 do not have coverage
c) The uninsured tend to be in worse health than the privately insured
d) The majority of uninsured adults have gone without coverage for a period of at
least two years
9) Which of the following is NOT true regarding lack of insurance and its affect on
access to health care services in 2005?
a) The uninsured pay the same rates that the insured pay on medical bills
b) The uninsured are up to three times more likely than those with insurance to
report problems getting needed medical care, even for serious conditions
c) Anticipating high medical bills, many of the uninsured are not able to follow
recommended treatment
d) Problems getting needed care also exist for uninsured children, who are
generally healthy and for whom access to care is a solid investment
e) Lack of health coverage, even for short periods of time, results in decreased
access to care
10) Which of the following is NOT true regarding lack of insurance and its affect on
access to health care services in 2005?
a) Access to health care improves after an uninsured person obtains health
insurance; similarly, losing coverage, whether it is private insurance or Medicaid,
substantially decreases access to care
b) The uninsured are less likely to receive timely preventive care

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c) The uninsured are ten times less likely than the insured to participate in
alternative medical practices
d) Because the uninsured are less likely than the insured to have regular outpatient
care, they are more likely to be hospitalized for avoidable health problems
e) Having insurance improves health overall and could reduce mortality rates for
the uninsured by 10-15%
11) Which of the following is NOT true regarding how the uninsured paid for medical
care in 2005?
a) Among the non-elderly in 2004, the costs of medical care received by those
uninsured for the full year were just over half that of those with insurance
b) Having health insurance makes a difference in the debt individuals and families
face because of medical bills
c) The uninsured are increasingly paying "up front" before services will be
rendered
d) Most of the uninsured don’t get health services for free or at reduced charge
e) Having health insurance does not make a difference to a person's credit history
12) Which of the following is NOT true regarding how uncompensated care was financed
in 2005?
a) The costs of uncompensated care were estimated to be about $41 billion (2004)
b) The federal uncompensated care funding that flows through Medicaid is a
major source of financing for health care providers that serve the low-income and
uninsured populations of uninsured
c) Federal spending on uncompensated care has not kept up with the recent
growth in the number of uninsured
d) The cost of uncompensated care will remain the same as the baby-boomer
generation reaches retirement age
e) The cost of uncompensated care provided by physicians (estimated at $5 billion
in 2001) is not directly or indirectly reimbursed by public dollars
13) Which of the following is NOT a reason why the number of uninsured has changed?
a) In the mid- and late-1990s, employer-sponsored coverage gradually
increased—fueled by a robust economy, low unemployment rates, increases in
real wages, and slower growth in health premiums
b) By 1999, the percentage of people covered by Medicaid stabilized, and modest
increases in private coverage helped to decrease the number of uninsured for the
first time in over a decade
c) Enrollment in both Medicaid and SCHIP increased between 2000 and 2004, in
response to greater numbers who qualified and also because of improved program
outreach efforts and streamlined enrollment systems
d) Public coverage had also increased among adults between 2000 and 2004, but
with Medicaid’s limits on adult eligibility, it was not enough to buffer the loss of
job-based coverage
e) By 2005, the number of non-elderly uninsured had stopped growing
14) Which of the following is NOT a reason why employer-sponsored insurance doesn’t
cover more Americans than it does (2006)?
a) Employer-sponsored health insurance is sensitive to sharp changes in health
insurance premiums

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b) Most of the low income Americans are able to pay for insurance premiums
when they work for a company that provides coverage
c) The economic downturn, which began in early 2001, coupled with the return of
double-digit inflation in health insurance premiums, decreased employer-
sponsored coverage again
d) In 2006, annual employer-sponsored group premiums cost, on average, $4,242
for individual coverage and $11,480 for family coverage of four
e) The share of employees who were covered by employer-sponsored insurance
(ESI) decreased markedly between 2001 and 2005, with a corresponding increase
in the share who were uninsured
15) Which of the following is NOT a reason why employer-sponsored insurance doesn’t
cover more Americans than it does (2006)?
a) In 2005, white-collar workers were far more likely to be uninsured than blue-
collar workers
b) Workers from low-income families have less access to job-based insurance,
even when benefits from a spouse’s job are considered
c) The required employee share of premiums makes employer-sponsored
coverage unaffordable for some, particularly low-wage workers
d) Employees of small businesses (less than 100 employees) are less likely than
those in larger firms to have health benefits offered to them
e) Health coverage varies both by industry and by type of occupation
16) Which of the following is NOT true about the role of Medicaid regarding the
uninsured?
a) SCHIP works as a complement to Medicaid by covering low-income children
not eligible for Medicaid and despite broad Medicaid and SCHIP eligibility for
low-income children, many eligible children are not enrolled in the programs
b) In contrast, the role of Medicaid for non-elderly adults is far more limited
c) There is no federal law that requires states to cover children under age 19 who
come from poor families
d) Medicaid covers the majority of people who are in fair or poor health
e) Some states have expanded Medicaid eligibility for low-income parents, but
most states continue to tie income eligibility levels for parents to former welfare
assistance levels
17) Which of the following is NOT true regarding what can be done to decrease the
number of uninsured?
a) Many of the recent proposals (2006) have taken approaches that combine
strategies in order to expand health insurance coverage incrementally
b) Expanding public coverage for the low-income uninsured by building on
Medicaid and SCHIP
c) Expanding private group coverage by bolstering the current employer-
sponsored system and/or building new group insurance options
d) Relying on employers to provide health care insurance plans to all employees
e) Subsidizing the purchase of private individual health insurance, making
coverage more affordable with tax credits or deductions delivered through the
federal income tax system
James Lamberg

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AnswerKey 7) D 15) A
HCM #1–2 8) B 16) C
1) B 17) E
2) E HCM #5 18) C
3) C 1) D
4) D 2) B HCM #10
5) A 3) E 1) B
6) B 4) A 2) C
7) D 5) C 3) E
8) E 6) C 4) B
9) C 5) A
10) C HCM #6–7 6) D
11) C 1) C 7) C
12) A 2) D 8) E
13) B 3) E 9) B
14) E 4) A 10) E
15) C 5) B 11) C
16) C 6) D 12) A
17) E 7) B 13) D
18) D 8) D
19) A 9) A HCM #11–12
20) B 10) A 1) A
21) D 11) E 2) E
22) C 12) C 3) C
23) B 13) D 4) B
24) A 14) B 5) E
25) E 15) E 6) B
26) C 16) E 7) D
27) D 17) A 8) B
18) D 9) A
HCM #3 10) C
1) D HCM #8–9 11) E
2) D 1) D 12) D
3) C 2) C 13) E
4) A 3) B 14) B
5) B 4) A 15) A
6) E 5) C 16) C
7) D 6) E 17) D
7) A
HCM #4 8) C
1) D 9) E
2) B 10) B
3) C 11) A
4) D 12) E
5) E 13) B
6) A 14) C

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