MPH Health Policy & Management 1 — Questions and Answers
Question 1: What does 'utilization review' mean in U.S. health care management?
- Tracking patient satisfaction scores
- Evaluating the appropriateness and necessity of health care services (Correct answer)
- Auditing hospital billing codes
- Monitoring staff performance and productivity
Correct answer: Evaluating the appropriateness and necessity of health care services
Utilization review is the process of evaluating whether health care services are medically necessary, appropriate, and cost-effective.
Question 2: The Affordable Care Act (ACA) introduced which key mechanism to expand coverage?
- A single-payer national health insurance system
- Mandatory employer-sponsored insurance for all companies
- Insurance marketplaces and Medicaid expansion (Correct answer)
- Medicare for individuals under age 65
Correct answer: Insurance marketplaces and Medicaid expansion
The ACA created state and federal health insurance marketplaces and expanded Medicaid eligibility to cover more low-income adults.
Question 3: A 'capitation' payment model means:
- Providers are paid per service rendered
- Providers receive a fixed payment per patient per period, regardless of services used (Correct answer)
- Patients pay a flat annual premium directly to providers
- Payments are based on outcomes achieved
Correct answer: Providers receive a fixed payment per patient per period, regardless of services used
In capitation, providers receive a fixed per-member-per-month payment, incentivizing cost-efficient care rather than volume of services.
Question 4: Which type of managed care organization (MCO) requires members to use network providers and obtain referrals from a primary care physician?
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO) (Correct answer)
- Point-of-Service (POS) plan
- High-Deductible Health Plan (HDHP)
Correct answer: Health Maintenance Organization (HMO)
HMOs require members to use a network of providers and obtain referrals from a designated PCP before seeing specialists.
Question 5: The term 'moral hazard' in health economics refers to:
- Unethical billing practices by providers
- The tendency to use more health services when insured because the individual doesn't bear full costs (Correct answer)
- The risk of adverse selection in insurance markets
- Conflicts of interest in health policy decision-making
Correct answer: The tendency to use more health services when insured because the individual doesn't bear full costs
Moral hazard describes the behavior in which insured individuals consume more health services than they would if they paid the full cost themselves.
Question 6: A SWOT analysis in health management examines:
- Staff, Workload, Operations, and Training
- Strengths, Weaknesses, Opportunities, and Threats (Correct answer)
- Systems, Workflows, Outcomes, and Targets
- Surveys, Waivers, Oversight, and Transparency
Correct answer: Strengths, Weaknesses, Opportunities, and Threats
SWOT analysis is a strategic planning tool that identifies internal strengths and weaknesses alongside external opportunities and threats.
MPH Health Policy & Management 1
What does 'utilization review' mean in U.S. health care management?