Assessment of Quality in Healthcare and Health Insurance Disputes

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12 Questions

What aspect of healthcare reflects on the performance of healthcare professionals?

Hospital mortality and morbidity rates

Why did Blue Cross / Blue Shield refuse to pay for surgery in the Katskee case?

The surgery was deemed medically unnecessary

What does Iatrogenesis refer to in healthcare?

Adverse events caused by medical treatment or care

Why did the court rule in favor of the insured in the Katskee case?

The insurance policy was unclear and had to be interpreted in favor of the insured.

What is a key consideration in assessing the quality of healthcare according to the text?

Recognizing that there is not always a single 'best' treatment for each medical condition.

What are some indicators involved in quality assessment in healthcare according to the text?

Resources, Process, and Outcome measures.

Which factor does NOT contribute to measuring the quality of healthcare according to the text?

Physician's personal life choices.

Iatrogenesis is a serious concern in healthcare because it refers to:

Errors or harm resulting from medical treatment.

Why is it important to understand what medical care is NOT, according to the text?

To avoid unnecessary procedures and prioritize patient safety.

What drives attention to quality and quality improvement in healthcare as per the text?

'Continuous quality improvement' ethos within healthcare.

Why are adverse events that impact patient care considered in measuring healthcare quality?

'Adverse events' have a direct relationship with patient safety and care quality.

In what way do complications from anesthesia impact healthcare quality?

They can result in serious issues related to patient safety.

This quiz covers the definition of health, the concept of illness, disputes with health insurance payors regarding medical necessity, and the role of courts in interpreting ambiguous insurance policies. It also touches on the importance of understanding what medical care entails for assessing healthcare quality.

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