#1
Which of the following is not a characteristic of fee-for-service healthcare payment?
Providers are paid for each service rendered
It incentivizes volume of services over quality
Encourages preventive care and wellness programs
Can lead to overutilization of healthcare services
#2
Which healthcare financing model involves pooling funds from multiple individuals or entities to pay for healthcare services?
Out-of-pocket payments
Social health insurance
Capitation
Direct contracting
#3
Which of the following is a characteristic of a single-payer healthcare system?
Multiple insurance companies compete for customers
Healthcare is funded by a single public agency
Providers are paid based on fee-for-service
Patients have complete control over their healthcare spending
#4
What is the purpose of risk pooling in healthcare financing?
To increase administrative costs
To ensure that only high-risk individuals receive coverage
To spread financial risk across a large population
To limit access to healthcare services
#5
Which of the following is a characteristic of a preferred provider organization (PPO)?
Patients must select a primary care physician (PCP)
Providers agree to accept negotiated rates for services
Patients require referrals to see specialists
Providers are paid a fixed monthly fee per patient
#6
What is the primary objective of managed care organizations (MCOs) in healthcare?
To maximize profits for shareholders
To minimize access to healthcare services
To control costs and quality of care
To provide unlimited access to healthcare services
#7
What is the primary purpose of capitation in healthcare financing?
To incentivize providers to deliver more services
To ensure equitable distribution of healthcare resources
To reimburse providers based on the volume of services provided
To shift financial risk from payers to providers
#8
In which healthcare organizational structure are the providers and insurers combined into a single entity responsible for both financing and delivering healthcare services?
Accountable Care Organization (ACO)
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Integrated Delivery System (IDS)
#9
Which of the following is a disadvantage of a fee-for-service payment model?
It encourages unnecessary medical procedures
It promotes cost containment
It incentivizes providers to focus on preventive care
It simplifies the billing process
#10
In a health maintenance organization (HMO), how are healthcare providers typically compensated?
Through fee-for-service payments
Through capitation payments
Through direct payments from patients
Through grants from the government
#11
Which of the following is a potential consequence of underinsurance?
Increased financial risk for individuals
Decreased utilization of healthcare services
Improved health outcomes
Lower healthcare costs
#12
In the context of healthcare financing, what is a risk corridor?
A type of insurance policy
A mechanism to stabilize insurance premiums
A measure of patient satisfaction
A payment made directly to healthcare providers
#13
What is adverse selection in the context of health insurance?
The tendency for healthier individuals to purchase more insurance coverage
The tendency for sicker individuals to purchase more insurance coverage
The practice of insurance companies denying coverage to high-risk individuals
The process of setting insurance premiums based on an individual's risk profile
#14
What is the main goal of value-based healthcare payment models?
To increase healthcare costs
To reward healthcare providers based on the volume of services provided
To incentivize high-quality, cost-effective care
To discourage preventive care measures
#15
What is the role of a healthcare actuary?
To perform medical procedures
To analyze financial risks and trends in healthcare
To provide direct patient care
To develop new pharmaceutical drugs
#16
Which of the following factors contributes to healthcare cost inflation?
Decreased administrative costs
Advancements in medical technology
Reduced utilization of healthcare services
Stringent cost-containment measures
#17
Which of the following is an example of a healthcare delivery model that emphasizes coordinated care and disease prevention?
Fee-for-service
Accountable Care Organization (ACO)
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)