MPH Health Policy & Management

Question 1

What does 'utilization review' mean in U.S. health care management?

Accepted Answer

Evaluating the appropriateness and necessity of health care services

Answer

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?

Accepted Answer

Insurance marketplaces and Medicaid expansion

Answer

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:

Accepted Answer

Providers receive a fixed payment per patient per period, regardless of services used

Answer

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?

Accepted Answer

Health Maintenance Organization (HMO)

Answer

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:

Accepted Answer

The tendency to use more health services when insured because the individual doesn't bear full costs

Answer

Moral hazard describes the behavior in which insured individuals consume more health services than they would if they paid the full cost themselves.

MPH - Master of Public Health Practice Test