11
39) Capitation refers to
A) payment of a fixed monthly amount to a health-care provider per enrolled patient, regardless
of the type or number of services provided.
B) a one-time fee that is paid to health care providers from insurance companies if the patient
enrolls in an HMO.
C) care received from salaried practitioners at a specific health care facility, such as a hospital or
clinic.
D) administrators and stockholders in a proprietary hospital determining the fee schedule for a
given fiscal year.
Skill: Understanding
Section: Health Insurance
Learning Outcome: 16.3
40) Drugs that can be purchased without a prescription as part of self-care are
A) over-the-counter drugs.
B) generic drugs.
C) brand-name drugs.
D) formulary drugs.
Skill: Understanding
Section: Conventional Health Care
Learning Outcome: 16.2
41) If you have moved to a new town and want to find a physician you can see for annual
wellness exams and the treatment of routine ailments, you are seeking a(n)
A) in–network practitioner.
B) allopathic practitioner.
C) internal medicine practitioner.
D) primary care practitioner.
Skill: Applying
Section: Conventional Health Care
Learning Outcome: 16.2
12
42) Concerns about HMOs include all of the following EXCEPT
A) questions about care allocation.
B) profit–motivated medical decision making.
C) the high cost of copayments.
D) questions about access to services.
Skill: Understanding
Section: Health Insurance
Learning Outcome: 16.3
43) What do preferred provider organizations (PPOs) and point of service (POS) plans have in
common?
A) Both provide service from in-network medical providers.
B) Both are designed to coordinate a patient’s care across various providers.
C) Both provide care from networks of independent doctors and hospitals.
D) Both allow patients to seek outside care but require patients to pay the extra cost.
Skill: Analyzing
Section: Health Insurance
Learning Outcome: 16.3
44) The federally funded health insurance program that covers 99 percent of the U.S. population
age 65 and older is
A) Medicare.
B) Medicaid.
C) Social Security.
D) COBRA.
Skill: Remembering
Section: Health Insurance
Learning Outcome: 16.3
45) If your PPO has an in-network coverage rate of 90 percent and an out–of-network coverage
rate of 60 percent, this means that
A) your deductible will decrease by 30 percent if you visit an out–of-network specialist.
B) you will be responsible for paying 40 percent of the costs associated with out–of–network
services.
C) you are more likely to be denied coverage for out–of-network services.
D) you can expect to pay 60 percent of costs for out–of-network services.
Skill: Applying
Section: Health Insurance
Learning Outcome: 16.3
13
46) If you are concerned about the costs of health care, which of the following practices should
you avoid?
A) obtaining recommended health screenings
B) maintaining a healthy weight
C) exercising regularly
D) using the emergency room for your routine health care
Skill: Applying
Section: Health Insurance
Learning Outcome: 16.3
47) All of the following are provisions of the Affordable Care Act (ACA) EXCEPT coverage for
A) preventive services.
B) preexisting conditions.
C) prescription medications.
D) young adults on a parent‘s plan through age 30.
Skill: Understanding
Section: Issues Facing Today’s Health Care System
Learning Outcome: 16.4
48) The ACA is intended to improve the quality of health care by emphasizing
A) emergency care.
B) surgical care.
C) preventative care.
D) rationed care.
Skill: Understanding
Section: Issues Facing Today’s Health Care System
Learning Outcome: 16.4
49) Which of the following statements is NOT true about costs in the U.S. health care system?
A) The U.S. spends more on health care than any other nation.
B) Growing rates of obesity are pushing costs higher.
C) New technologies are lowering costs.
D) Overtreatment is an issue.
Skill: Understanding
Section: Issues Facing Today’s Health Care System
Learning Outcome: 16.4
14
50) The health insurance program jointly funded by the states and the federal government that
provides coverage for low-income individuals and families is
A) Medicare.
B) Medicaid.
C) Social Security.
D) COBRA.
Skill: Understanding
Section: Health Insurance
Learning Outcome: 16.3
51) Managed care is based on
A) coordination of health care.
B) doctors setting their own rates.
C) few administrative rules.
D) emergency health care.
Skill: Understanding
Section: Health Insurance
Learning Outcome: 16.3
52) One of the advantages of a single-payer health care system is that it
A) can achieve lower cost through economies of scale.
B) provides a higher quality of health care.
C) rations health care services.
D) encourages people to commit to lifestyle choices that reduce their risk for chronic diseases.
Skill: Understanding
Section: Issues Facing Today’s Health Care System
Learning Outcome: 16.4
53) Categories established by the federal government to determine how much a hospital will be
reimbursed for the care of a patient with a particular condition or multiple conditions are
A) diagnosis-related groups.
B) fee schedules.
C) formulary tiers.
D) diagnostic codes.
Skill: Understanding
Section: Health Insurance
Learning Outcome: 16.3
15
54) Which type of health insurance plan involves a contracted provider network and a focus on
preventive care and cost control?
A) fee-for-service
B) managed care
C) indemnity
D) hospital-owned
Skill: Understanding
Section: Health Insurance
Learning Outcome: 16.3
55) A payment made to an insurance company, usually on a monthly basis, to cover the cost of
an insurance policy is the
A) deductible.
B) premium.
C) waiting period.
D) lifetime limit.
Skill: Understanding
Section: Health Insurance
Learning Outcome: 16.3
56) Medical decision making based on clinical expertise, patient values, and data from scientific
research is known as
A) allopathic medicine.
B) evidence-based practice.
C) conventional medical care.
D) primary practice.
Skill: Understanding
Section: Conventional Health Care
Learning Outcome: 16.2
57) Approximately what percentage of Americans currently uses one or more prescription drugs?
A) nearly 10 percent
B) nearly 40 percent
C) nearly 70 percent
D) nearly 90 percent
Skill: Remembering
Section: Conventional Health Care
Learning Outcome: 16.2
16
58) The placebo effect is the disappearance of symptoms without any apparent reason or
treatment.
Skill: Understanding
Section: Taking Responsibility for Your Health Care
Learning Outcome: 16.1
59) All patients have the legal right to access their medical records.
Skill: Understanding
Section: Taking Responsibility for Your Health Care
Learning Outcome: 16.1
60) An osteopath (D.O) does not complete the same level of training as a physician who is an
M.D.
Skill: Understanding
Section: Conventional Health Care
Learning Outcome: 16.2
61) Regular self-care should include learning about health from reliable health care publications,
including websites.
Skill: Understanding
Section: Taking Responsibility for Your Health Care
Learning Outcome: 16.1
62) Allopathic medicine is based on scientifically validated methods and procedures.
Skill: Understanding
Section: Conventional Health Care
Learning Outcome: 16.2
63) An optometrist holds a medical degree and can perform eye surgery.
Skill: Understanding
Section: Conventional Health Care
Learning Outcome: 16.2