SHORT ANSWER Answer ALL of the following (one half point each) 1. What are the three main payment mechanisms managed care uses? In each mechanism, who bears the risk? 2. Explain the differences between PPO, HMO, and POS managed care models. 3. Has the quality of health care gone down as a result of managed care? Why? 4. What is patient activation? What are the main challenges in activation? 5. What is utilization monitoring and control? Describe the three utilization review methods. 6. What was one news item reported by another student this semester that you found most interesting? Why? LONG ANSWER Answer TWO of the following (2 points each) 1. Long-term care services must be individualized, integrated, and coordinated. What is meant by the continuum of institutional long-term care? Discuss the clinical services delivered by residential/personal care facilities, assisted living facilities, and skilled nursing facilities. Why are ALFs the fast growing area of long-term care? 2. Give some notable impacts on the evolution of the hospital. Describe the five stages of hospital evolution. Provide reasons from growth and expansion of hospitals from the late 1800s to mid-1980s. Discuss the role of government in the growth and decline of hospitals in the United States. Describe the three main forces that have been responsible for hospital downsizing. 3. How do MCOs seek to achieve cost efficiencies? What are some of the inefficiencies created by managed care? What is a prospective payment system and how is it related to managed care? To what extent has managed care been successful in containing health care costs? What role is managed care expected to play under the Affordable Care Act? 4. Why do organizations choose to integrate their businesses or services? Discuss the difference between merger, acquisition, joint venture, organizational integration, and alliance. When is one a more preferable integration strategy over another? 5. Define physician-owned hospitals and provide some findings by the MedPAC study. Discuss ethical issues inherent in physician-owned hospitals. What are the requirements for participation in Medicare? How has ACA sought to further regulate physician-owned hospitals 6. Describe the four major principles of bioethics in both research and health care delivery. Explain some of the major historical events found to be unethical leading to establishing these principles. How do ethics apply specifically to hospitals? Answer ONE of the following (2 points each) 1. Describe the three different meanings (perspectives) of the term \"cost.\" What are some of the reasons for increased healthcare costs attributable to the providers of medical care? Describe some regulatory and competitive approaches to cost containment. Which is more \"top-down\" and which is more \"bottom-up?\" What are some of the main differences between broad cost-containment approaches used in the United States and those used in other countries (example)? 2. What are the types (five dimensions) of access? Briefly describe the measurement of access at the individual, health plan, and delivery system levels. What are the implications of access for health and healthcare delivery? How is access to care a determinant of health? What is the role of enabling and predisposing factors in access to care? How does the Affordable Care Act address issues of access? 3. Provide an overview of the dimensions of quality from the micro- and macroperspectives. Define the two types of quality of life. How are these measured? Does quality of life fall under the macro- or micro-perspective of quality? Distinguish between quality assessment and quality assurance. What are the basic principles of TQM (or CQI)? Give a brief description of the Donabedian model of quality. Answer ONE of the following (2 points each) 1. What are the principal features of US health policy? Why do these features characterize US health policy? Describe ways in which health policies can be used as regulatory or allocative tools, include definitions of \"distributive\" and \"redistributive\" allocation. Which raises more political controversy? 2. Thoroughly describe the main features that characterize U.S. health care policy. How do these features relate (or not relate) to our U.S. value system described in chapter 2? What are interest groups? Give examples of the political agendas of different groups. 3. Describe the stages in the policy cycle. Briefly apply the policy cycle to the evolution of the ACA. Describe the critical policy issues related to access to care, cost of care, and quality of care and give examples of ways in which the ACA addresses all three. Answer BOTH of the following (2 points each) 4. Describe the framework of vulnerability. Select one marginalized or vulnerable population and describe some health concerns specific to this population. Are there any health outcomes that stand out as poorer for this group? What might be some converging predisposing, enabling or risk factors (or convergence of risks) faced by this population? Are there any government or private organizations that address the unique needs of this population? 5. Describe different forms of highly integrated health care systems. What might be some advantages to these models? Do you see any disadvantages? Refer to the video we watched \"The Good News in American Medicine\" (http://video.pbs.org/video/2198039605/). Describe at least one of the models depicted in this film. What did you see as advantages to that model? Disadvantages? Answer the following (2 points) 6. Explain the eight main forces that will determine future change in health care. Make one health care prediction (access, workforce, cost, universal coverage, national health system, value system, etc.) for the future (give a time frame) and explain WHY exactly you are making this prediction referring back to some of the eight forces