Assessment of Quality in Healthcare and Health Insurance Disputes

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Questions and Answers

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

  • Hospital mortality and morbidity rates (correct)
  • Patient satisfaction rates
  • Quality improvement initiatives
  • Compliance policy effectiveness

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

  • The surgery was deemed medically unnecessary (correct)
  • The surgery was not performed by a licensed physician
  • The surgery was too costly for the insurance company
  • The surgery was experimental and not covered by the policy

What does Iatrogenesis refer to in healthcare?

  • Excessive patient demand for unnecessary medical procedures
  • Adverse events caused by medical treatment or care (correct)
  • Natural recovery from an illness without medical intervention
  • Insufficient resources available to provide quality healthcare

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

<p>The insurance policy was unclear and had to be interpreted in favor of the insured. (D)</p> Signup and view all the answers

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

<p>Recognizing that there is not always a single 'best' treatment for each medical condition. (C)</p> Signup and view all the answers

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

<p>Resources, Process, and Outcome measures. (A)</p> Signup and view all the answers

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

<p>Physician's personal life choices. (B)</p> Signup and view all the answers

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

<p>Errors or harm resulting from medical treatment. (D)</p> Signup and view all the answers

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

<p>To avoid unnecessary procedures and prioritize patient safety. (D)</p> Signup and view all the answers

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

<p>'Continuous quality improvement' ethos within healthcare. (A)</p> Signup and view all the answers

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

<p>'Adverse events' have a direct relationship with patient safety and care quality. (A)</p> Signup and view all the answers

In what way do complications from anesthesia impact healthcare quality?

<p><strong>They can result in serious issues related to patient safety.</strong> (B)</p> Signup and view all the answers

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