Post Test: Managed Care Ethics
Text: Ethical Issues for Behavioral Healthcare Practitioners
and Organizations in a Managed Care Environment
by: John Petrila, J.D., LL.M.
Exam Copyright (c) 2000 by:
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A. INTRODUCTION
1. The therapist in today's behavioral health care system often enjoys
_______ discretion than in a fee-for-service system..
A) more
B) less
C) the same
D) A or C
2. The central ethical questions in a managed care environment flow
from ________.
A) a more explicit concern with cost.
B) a changed therapist-client relationship.
C) involvement of payers in individual treatment decisions.
D) none of the above.
B. ALLOCATON OF RESOURCES
3. There is ______ evidence that unlimited expenditures on health care
necessarily yield better health care outcomes, regardless of how "better
health outcomes" is defined.
A) no
B) mounting scientific
C) anecdotal
D) B and C
4. To the degree that rationing of health care resources may exist, such
rationing is based on:
A) principles agreed upon by payers and professionals.
B) the financial resources of clients.
C) principles put forth by President Clinton in his health care proposal.
D) no agreed upon criteria.
5. __________ is/are among the ethical issues complicating the task of
creating a coherent ethical base for the behavioral health care system.
A) Behavioral health care benefits have lagged behind general health
care benefits in both privately funded and publicly funded systems.
B) The availability of coercion and the conditions under which it may be
properly used in the delivery of behavioral health care services to clients.
C) A and B
D) Neither A nor B
C. TREATMENT PROVIDER OBLIGATIONS
6. The first core ethical principle that governs the relationship between
treatment provider and client is _______:
A) do no harm.
B) the practitioner is a fiduciary, whose primary obligation is to act in the
client's best interest.
C) the therapist's primary responsibility is to prevent harm being done to a
client.
D) B and C
7. The ethical and legal rule of autonomy holds that competent
individuals as a general rule have control over health care decisions.
A) TRUE
B) FALSE
8. If the economic interests of the treatment provider are at odds with the
interests of the client, a treatment provider:
A) is obligated to provide those services agreed upon between the
therapist and the client's payer.
B) is not obligated to provide treatment the client cannot pay for.
C) is obligated to provide the treatment he or she believes is best suited
to the client's need under these circumstances.
D) B and C
9. Which of the following are mandatory elements of informed consent?
A) It must be voluntary.
B) It must be competent.
C) It must be knowledgeable.
D) A, B, and C
10. The process by which the decision was reached was unimpeded by
mental or emotional illness or other factors, for example, substance abuse
as a test for competence:
A) is in common use today.
B) is biased towards treatment refusal.
C) is rarely used today.
D) applies only to those clients being treated involuntarily.
11. As a general rule, an individual must be:
A) less competent the more intrusive or invasive the treatment procedure.
B) equally competent to consent to more or less intrusive or invasive
treatments.
C) more competent the more intrusive or invasive the treatment
procedure.
D) declared incompetent by a court before he/she can refuse invasive or
intrusive treatment.
12. Under what circumstances is it ethically permissible to withhold
information from a client about risks associated with a proposed
treatment?
A) When such information would unduly raise a client's anxiety if
revealed.
B) When the risk is small.
C) When the benefits clearly outweigh the risk to the treatment.
D) Under no circumstances.
13. Consent will be assumed in an emergency when the client is unable
to give consent.
A) TRUE
B) FALSE
14. Substitute consent for treatment may be obtained when:
A) the individual involved is a child under 16.
B) the individual has designated a "health care proxy" before becoming
incapacitated.
C) A and B
D) Only when a person has been declared incompetent by the court to
make decisions.
D. IMPACT ON CORE PRINCIPLES
15. If a provider signs a contract with a managed care company to
provide services to their members, the provider incurs:
A) legal obligations.
B) contractual obligations.
C) A and B
D) None of the above
16. Clinicians may be liable to what kind of legal action as contractors
with managed care organizations?
A) Negligence or malpractice if services are terminated or curtailed
because of reimbursement and the client suffers an adverse outcome.
B) Breach of contract for failure to provide services guaranteed in the
client's managed care contract
C) The same actions as apply to fee for service systems.
D) A and B
17. In Wickline v. California the court decided that third party payers:
A) can be held legally accountable when medically inappropriate
decisions result from defects in the design of implementation of
cost-containment mechanisms.
B) cannot be held legally accountable when medically inappropriate
decisions result from defects in the design of implementation of
cost-containment mechanisms.
C) are responsible for poor medical decisions made by physicians
intimidated by their reimbursement policies.
D) A and C
18. Who retains ultimate responsibility for care even in the face of a lack
of reimbursement?
A) The provider/treater.
B) The managed care company.
C) Both equally.
D) The client.
19. Recent opinions by courts regarding the responsibility of providers to
continue care even if reimbursement is in question are a tacit guarantee
for lifetime care to clients.
A) TRUE
B) FALSE
20. Under what circumstances may health care resources legitimately be
withheld?
A) None
B) When the provision of services would put an economic burden on a
client's family.
C) When further interventions would be of no value.
D) B and C
21. John Sabin suggests that treatment providers:
A) must look beyond the needs of the individual to societal interests.
B) must not be coerced into looking beyond the individual's needs to
societal needs.
C) have an obligation to act as stewards of health care resources.
D) A and C
22. It is unethical for a clinician to utilize the least expensive, clinically
appropriate services available.
A) TRUE
B) FALSE
23.Individuals with little choice regarding their providers, such as
Medicaid recipients and other managed care clients
A) retain a limited right of autonomy in making decisions about their health
care.
B) forego their right of autonomy in lieu of guaranteed benefits under the
managed care system.
C) retain the right of autonomy in making decisions about their health
care.
D) must choose treatment options from those offered by the managed
care plan.
24. Individuals with mental illness and substance abuse disorders:
A) retain the same rights as others to decline treatment.
B) retain the right to decline treatment, absent an emergency or
application of the state's rules permitting the ordering of treatment when it
has been refused.
C) do not have the right to refuse treatment that is not invasive or
intrusive.
D) cannot be presumed competent to refuse treatment, although they
retain the right to accept treatment.
25. The fact that a person has been ordered into care directly conflicts
with the ethical principle of:
A) Autonomy
B) Independence.
C) Coercion.
D) A and C
26. A clinician in either a managed care or a fee-for-service environment
must disclose to the client any conflicts that might affect the provider's
clinical judgment, only if the clinician thinks this is a realistic possibility.
A) TRUE
B) FALSE
27. __________ means that the treatment provider, as part of the
informed consent process attempts to ascertain whether the client is
aware of limitations on services available to the client resulting from
provisions in the client's insurance or managed care plan.
A) Expanded informed consent
B) Pretreatment financial screening
C) Economic informed consent
D) Financial evaluation
28. Who among the following are ethically obligated to discuss with a
managed care client benefit limitations?
A) The payer.
B) The client is responsible for knowing which benefit are in his/her plan.
C) The state or federal entities regulating the managed care plan.
D) The practitioner.
29. When should a discussion of the limitations of benefits and other
economic issues occur between a client and a practitioner?
A) At the beginning of the relationship.
B) If economic issues begin to have an effect of the therapeutic alliance.
C) If the client fails to make regular payments.
D) At the last or next to last session.
E. ORGANIZATIONAL ETHICS
30. If the individual heading the behavioral health care organization is a
licensed practitioner,:
A) he or she ceases to have ethical responsibilities flowing from that
license that arguably carry over to his/her role as an administrator.
B) he or she has ethical responsibilities flowing from his/her role as
administrator.
C) he or she continues to have ethical responsibilities flowing from that
license that arguably carry over to his/her role as an administrator.
D) ethical responsibilities do not apply to administrative positions.
31. What ethical responsibility does a behavioral health care organization
that loses clients to another provider because of a managed care
contract retain?
A) The organization must inform the clients about the reputation, good
and bad, of the receiving organization.
B) There are no specific ethical obligations imposed on an organization in
these circumstances.
C) Only those responsibilities imposed by state law.
D) To ensure that the transition in care causes as little harm as possible
to the affected clients.
32. It is ethical for a clinician to practice outside the scope of his/her
competence if:
A) failure to do so would interfere with the delivery of optimum care to
clients.
B) a person with the required licensure is available for consultation and
supervision.
C) the clinician is complying with a contractual agreement he/she has
with the organization.
D) none of the above
33. Upon whom is it incumbent to ensure that a practitioner has both the
training and experience necessary to provide adequate treatment within
a managed care plan's limits?
A) The treatment provider.
B) The managed care company.
C) The behavioral health care organization.
D) The client seeking treatment.
34. Clinicians who accept bonuses for referrals of clients:
A) are engaging in acceptable business practices if the care delivered is
equivalent to or better than the community standard of care.
B) cannot make a neutral decision about the appropriateness of the
referral.
C) are violating ethical principles of informed consent.
D) B and C
F. ADDRESSING ISSUES
35. Formal processes for addressing ethical issues in a behavioral health
care organization should include which of the following:
A) an ethics committee.
B) a workable grievance process.
C) adoption of a code of ethics for all providers.
D) both A and B above
36. Which of the following principles are not included in the Ethical
Guidelines for Managed Care Contracting formulated by the Shared
Corporate Ethics Committee?
A) Special Responsibility for the Seriously Impaired.
B) Titled Dignity of the Human Person.
C) Dignity Can Only Be Protected and Realized in the Community.
D) Special Responsibility for the Poor.
37.Ethics committees in managed care organizations should not include
members of the business and personnel sides of the organization
because of the conflict of interest they might have between the
organization's interests and the clients.
A) TRUE
B) FALSE
38. An appropriate outside member of a managed care organization
ethics committee might be:
A) an ethicist.
B) a consumer.
C) a family member of a consumer.
D) A, B and C
39. Federal and State law require _____________ to have formal
grievance procedures to address consumer complaints.
A) health maintenance organizations
B) managed care companies
C) A and B
D) Neither A nor B
40. Which of the following elements are not legally required for entities
that must have a formal grievance process?
A) Training of staff in the grievance process and its importance to the
organization.
B) Posting of information regarding the grievance process.
C) Designation of an individual who is responsible for overall
administration of the grievance process.
D) All are required.
41. On whom does the burden for ensuring that practice conforms to
ethical principles, and for reconciling the tension between cost
containment and client treatment needs, fall on?
A) The managed care organization ethics committee.
B) The chief clinical officer of the organization.
C) The practitioner.
D) all of the above equally.
42. In his work on ethics for behavioral health care practitioners, Dr.
James Sabin concludes that practitioners should consider _______ in
making ethical decisions about caring for clients?
A) acceptance of responsibility to the client
B) acceptance of responsibility to the client and to society
C) use of the most efficacious treatment available without regard to cost
D) promotion of the greatest good for the people at highest risk
43. How do the authors suggest clinicians can ethically act as advocates
for benefits which are in their clients best interest?
A) By pursuing formal appeals processes established by the managed
care plan.
B) Going beyond the managed care appeals process to persuade the
plan's administrators to make available benefits the clinician believes are
appropriate.
C) Act through professional organizations to advocate for ethically based
managed care plans.
D) A, B and C
44. Before entering a managed care contract, a behavioral health care
provider:
A) should consult a lawyer skilled in interpreting contracts to determine if
the contract is to his/her benefit.
B) should consult with his/her professional organization to determine if
the contract conforms with the organizations ethical standards.
C) should determine if the plan provides flexibility in the rules that prevent
the practitioner from being tempted into unethical practices.
D) A and B
45. The definition of __________ generally will control reimbursement
decisions in a managed care system.
A) available benefit
B) medical necessity
C) most efficacious treatment
D) covered diagnosis
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