MPH Health Policy & Management 2 — Questions and Answers
Question 1: Adverse selection in health insurance markets occurs when:
- Insurers deny coverage to high-risk individuals
- Sicker individuals are more likely to purchase insurance, raising costs for insurers (Correct answer)
- Employers select plans with inadequate benefits
- Government mandates limit consumer choice
Correct answer: Sicker individuals are more likely to purchase insurance, raising costs for insurers
Adverse selection occurs when individuals with higher health risks disproportionately enroll in insurance plans, creating an imbalanced risk pool that drives up costs.
Question 2: What is the primary function of a Certificate of Need (CON) law?
- To certify hospital staff credentials
- To regulate new health facility construction and major capital expenditures (Correct answer)
- To mandate minimum nurse-to-patient ratios
- To license physicians practicing across state lines
Correct answer: To regulate new health facility construction and major capital expenditures
CON laws require health care providers to obtain state approval before adding services or facilities, intended to prevent duplication and control costs.
Question 3: The 'triple aim' in health care, introduced by IHI, refers to:
- Quality, Safety, and Efficiency
- Improving population health, enhancing patient experience, and reducing per capita costs (Correct answer)
- Access, Affordability, and Accountability
- Prevention, Treatment, and Rehabilitation
Correct answer: Improving population health, enhancing patient experience, and reducing per capita costs
The Triple Aim framework focuses simultaneously on improving the health of populations, enhancing the patient care experience, and reducing health care costs.
Question 4: Which entity accredits hospitals and health care organizations in the United States?
- Centers for Medicare & Medicaid Services (CMS)
- American Hospital Association (AHA)
- The Joint Commission (TJC) (Correct answer)
- Agency for Healthcare Research and Quality (AHRQ)
Correct answer: The Joint Commission (TJC)
The Joint Commission is the primary independent accreditation body that evaluates and accredits thousands of health care organizations and programs in the U.S.
Question 5: A 'global budget' in health policy refers to:
- International funding for health programs
- A fixed annual spending cap for a health system or region (Correct answer)
- A line-item budget covering all government health expenses
- Funding allocated to global health NGOs
Correct answer: A fixed annual spending cap for a health system or region
A global budget sets a total fixed amount that a hospital or health system can spend in a given year, incentivizing cost containment across all services.
Question 6: Which of the following best describes a 'pay-for-performance' (P4P) reimbursement model?
- Providers are paid based on the number of patients seen
- Providers receive bonuses or penalties based on quality and outcome metrics (Correct answer)
- Payments are made prospectively based on diagnosis-related groups
- Patients share costs through higher copayments for specialty care
Correct answer: Providers receive bonuses or penalties based on quality and outcome metrics
Pay-for-performance ties reimbursement to quality measures and patient outcomes rather than volume of services, aiming to improve care quality and efficiency.
MPH Health Policy & Management 2
Adverse selection in health insurance markets occurs when: