CHAPTER 12: Health Policy and Regulation
MULTIPLE CHOICE
1. ____ is the governmental oversight of the private marketplace.
a.
Allegiance
c.
Control
b.
Procedure
d.
Regulation
2. An example of an agency within the Department of Health and Human Services is the ____.
a.
National Institutes of Health (NIH)
b.
National Physicians Institute (NPI)
c.
Committee for Health and Cooperation (CHC)
d.
Center for Family Medicine (CFM)
3. One challenge that the Food and Drug Administration (FDA) faces is to balance the public demand for
speedy access to newly developed drugs against the ____ that might accompany an accelerated
approval process.
a.
excitement
c.
risks
b.
rewards
d.
failures
4. A ____ is used by the IRS for assessing whether hospitals are operated to serve a charitable purpose.
a.
community reduction standard
b.
community benefit standard
c.
common benefit structure
d.
common reduction structure
5. The ____ (HIPAA) limits the ability of new employers to exclude coverage for preexisting conditions.
a.
Health Insurance Portability and Accountability Act
b.
Health Inspection Portability and Accountability Act
c.
Heath Insurance Preferentially and Accountability Act
d.
Health Inspection Preferentially and Accountability Act
6. The ____ of 1986 is designed to prevent institutions from denying care to anyone seeking emergency
medical treatment, regardless of citizenship, insurance status, or ability to pay.
a.
Emergency Medical Transfer and Litigation Act (EMTALA)
b.
Emergency Medical Treatment and Labor Act (EMTALA)
c.
Emergency Medical Treatment and Litigation Act (EMTALA)
d.
Emergency Medical Transfer and Labor Act (EMTALA)
7. The ____ stores information regarding physicians’ and dentists’ professional competence and conduct.
a.
National Practitioner Data Bank (NPDB)
b.
Network of Competencies Data Bank (NCDB)
c.
National Record of Health Care Provider Competencies (NRHCPC)
d.
Network of Known Practitioner Errors (NKPE)
8. In many states, a health care facility cannot be constructed, renovated, or expanded without obtaining a
____.
a.
contract of negotiation (CON)
c.
certificate of need (CON)
b.
contract of need (CON)
d.
certificate of negotiation (CON)
9. The 1999 report by the Institute of Medicine, To Err is Human: Building a Safer Health System, stated
that between ____ deaths could be attributed to preventable medical errors.
a.
400 and 980
c.
44,000 and 98,000
b.
4,000 and 9,800
d.
440,000 and 980,000
10. An emerging cost containment strategy is to encourage comparative ____ research.
a.
physician output
c.
clinical effectiveness
b.
practitioner competency
d.
health care incentive
COMPLETION
1. With the increasing intersection between health care delivery and the law, health care executives must
confront a wide range of regulatory ____________________ issues that affect how health care
institutions operate.
2. ____________________, created by a 1965 statute, is the federal health insurance program for the
elderly and disabled.
3. “____________________” authority allows the Centers for Medicare and Medicaid Services (CMS) to
state that a health care organization meets CMS certification requirements.
4. The purpose of the ___________________ laws is to promote competition based on the conviction
that competitive markets bring benefits of relatively lower consumer prices, higher output, and greater
innovation.
5. The United States health care industry comprises a relatively large number of organizations that are
____________________ from paying most if not all taxes including income, property and sales taxes.
6. The Department of Health and Human Services (HHS) ____________________, with the cooperation
of the Department of Justice, dedicates considerable resources to enforcing federal fraud and abuse
laws.
7. One concern that the Health Care Quality Improvement Act (HCQIA) addressed was the weaknesses
in existing peer ____________________ processes.
8. ____________________ serves as a primary mechanism by which states regulate the quality of care
provided by health care organizations.
9. ____________________ principles affect the interaction between federal and state laws, stating that if
federal and state laws directly conflict, the federal law applies.
10. To successfully navigate through the complex regulatory environment, health care organizations
(HCOs) often appoint a regulatory ____________________.
MATCHING
Match each item with a statement below:
a.
Sherman Act
b.
Administrative Procedures Act
c.
False Claims Act (FCA)
d.
Department of Health and Human Services (HHS)
e.
Stark Physician Self-Referral Law (Stark)
f.
Prospective Payment System (PPS)
g.
Anti-Kickback Statute (AKS)
h.
Medicaid
i.
Clayton Act
j.
Food and Drug Administration
1. Prohibits knowingly submitting or causing to be submitted a false claim to the government
2. Combined federal and state program that provides medical assistance to low-income individuals and
3. Determines the process of promulgating regulations
4. Principal federal government agency for health care
5. Fixed payment system for inpatient services based on a patient’s specific diagnosis within Medicare
system
6. Prohibits physicians from referring patients to certain health services providers with which the
physicians have a financial relationship
7. Prohibits mergers, acquisitions and joint ventures that threaten to substantially lessen competition or
are likely to create a monopoly
8. Exercises influence through regulatory efforts to ensure the safety and efficacy of drugs and medical
devices
9. Prohibits contracts and other agreements that unreasonably restrain trade
10. Prohibits the knowing and willful solicitation or receipt of remuneration by any person in connection
with items or services for which payment could be made by Medicare or Medicaid
