The least effective method of paying health care providers in terms of driving efficiency, as this motivates providers to over-provide

services:

a.
Global Budget

b.
Fee-for-service

c.
Capitation

d.
Case-based payments

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Fee-for-service

Question 2
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The implementation of the Global Budget by PhilHealth will be based on the following:

a.
Diagnosis-related groups for inpatient hospital services

b.
Capitation scheme for primary care services

c.
Fee-for-service scheme for private health care providers

d.
All-case rates method for individual-based health packages

e.
Only A and B are correct.

f.
Only A, B and C are correct.

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Only A and B are correct.

Question 3
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PhilHealth’s current provider-payment mechanism:

a.
Global Budget

b.
Diagnosis-Related Groups

c.
All Case Rates Method

d.
Provider Payment Mechanism

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The correct answer is:

All Case Rates Method

Question 4
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The agency responsible to develop monitoring tools to track the implementation of the No Co-Payment Policy:

a.
Commission on Audit

b.
Local Government Unit

c.
Department of Health

d.
Philippine Health Insurance Corporation

e.
All of the above

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Philippine Health Insurance Corporation

Question 5
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The number assigned to each DRG that reflects resource intensity based on collected cost data:

a.
Base rate

b.
Adjustment Factor

c.
DRG rate

d.
Relative Weight (RW)

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The correct answer is:
Relative Weight (RW)

Question 6
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The provision of regular meal, bed in shared room, fan ventilation, and shared toilet and bath during hospital confinement:

a.
Basic accommodation

b.
Non-basic accommodation

c.
Suite room accommodation

d.
Fringe accommodation

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Basic accommodation

Question 7
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The following correctly differentiates No Balance Billing policy from No Co-Payment policy:

a.
The No Balance Billing policy is based on the mandate of the UHC Act whereas the No Co-Payment policy is based on the IRR of the National Health Insurance Act.

b.
The No Balance Billing policy covers all membership categories of PhilHealth whereas the No Co-Payment policy covers only the indirect contributors.

c.
The No Balance Billing policy is based on membership categories whereas the No Co-Payment policy is based on the hospital accommodation type.

d.
All of the above are correct.

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The correct answer is:

The No Balance Billing policy is based on membership categories whereas the No Co-Payment policy is based on the hospital accommodation type.

Question 8
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The general term for the way PhilHealth will pay health care providers for services delivered to the covered population:

a.
Global Budget
 b.
Diagnosis-Related Groups

c.
All Case Rates Method

d.
Provider-Payment Mechanism

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The correct answer is:

Provider-Payment Mechanism

Question 9
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The direct payment of a portion of health care costs by an insured person when receiving health services:

a.
Co-insurance

b.
Cost-sharing

c.
Co-payment

d.
Health benefit coverage

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The correct answer is:

Cost-sharing

Question 10
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Method of paying health care providers based on bundling together sets of health services and resources into single payment amounts:

a.
Fee-for-service

b.
Global Budget

c.
Capitation

d.
Case-based payments

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The correct answer is:

Case-based payments
Question 11
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All health care providers shall comply with the prescribed allocation of basic and non-basic accommodation within their facilities. Which of the following bed ratios stated in the
Universal Health Care Act is correct?

a.
All government hospitals shall allocate at least 90% of their approved bed capacity to non-basic accommodation.

b.
All government specialty hospitals shall allocate at least 90% of their approved bed capacity to basic accommodation.

c.
All private hospitals shall allocate 70% of their approved bed capacity to non-basic accommodation.

d.
All private hospitals shall allocate 10% of their approved bed capacity to basic accommodation.

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All private hospitals shall allocate 10% of their approved bed capacity to basic accommodation.

Question 12
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The following member categories are covered by the current No Balance Billing (NBB) policy, EXCEPT:

a.
Kasambahay

b.
Indigent member

c.
Individual paying member

d.
Lifetime member

e.
Sponsored member

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The correct answer is:

Individual paying member

Question 13
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A patient who opt for non-basic accommodation is charged a form of co-payment for hospital services, professional fees, and fringe or additional amenities. The following are
considered as examples of fringe or additional amenities:
 a.
Air-conditioning

b.
Regular meals

c.
Telephone

d.
Common bathrooms

e.
Only A and C are correct.

f.
Only A, B and C are correct.

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The correct answer is:

Only A and C are correct.

Question 14
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The following document is the primary basis for the transfer of funds from DOH to the LGU:

a.
Administrative Order

b.
Sub-Allotment Guidelines

c.
Memorandum of Understanding

d.
Terms of Partnership

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The correct answer is:

Terms of Partnership

Question 15
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Method of paying health care providers based on the number of people within their catchment area:

a.
Capitation

b.
Global Budget
 c.
Case-based payments

d.
Fee-for-service

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The correct answer is:

Capitation

Question 16
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The three main functions of an effective health financing system:

a.
revenue generation, pooling, strategic purchasing

b.
prospective payment, network-based payment, frontloading

c.
All Case Rates, Diagnosis-Related Groups, Global Budget

d.
capitation, fee-for-service, case-based

e.
None of the above

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The correct answer is:

revenue generation, pooling, strategic purchasing

Question 17
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The appropriation of the budget from the following LGU fund requires an ordinance passed by the Sanggunian:

a.
General Fund

b.
Special Health Fund

c.
Special Fund

d.
Trust Fund

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The correct answer is:

General Fund
Question 18
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This entity has the full responsibility in the management of the Special Health Fund:

a.
Local Chief Executive

b.
Provincial/City Health Board

c.
Sanggunian Panlalawigan/ Panlunsod

d.
Provincial/ City Budget Officer

e.
All of the above

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Provincial/City Health Board

Question 19
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The flat fee or predetermined rate paid at the point-of-service:

a.
Co-payment

b.
Co-insurance

c.
Health benefit coverage

d.
Cost-sharing

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The correct answer is:

Co-payment

Question 20
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The following reflects the major steps in the management of the Special Health Fund:
 a.
creation; planning and budgeting; disbursement and utilization; monitoring, transparency and accountability

b.
call for P/CWHS to open SHF depository bank account; contract negotiation; authorization and approval of SHF budget; submission of utilization report

c.
organization of the P/CHB and its support units; signing of contracts with stakeholders; disbursement and utilization; budget accountability

d.
None of the above

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creation; planning and budgeting; disbursement and utilization; monitoring, transparency and accountability

Question 21
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The following are the possible sources of funds for the Special Health Fund:

a.
Financial grants from the national government

b.
LGU budget for health

c.
Revenues from PhilHealth payments

d.
All of the above are correct.

e.
Only A and C are correct.

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The correct answer is:

All of the above are correct.

Question 22
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The provision of minimum standards of care for patients including fringe or additional amenities at the option of the patient during hospital confinement:

a.
Non-basic accommodation

b.
Suite room accommodation

c.
Basic accommodation
 d.
Fringe accommodation

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The correct answer is:

Non-basic accommodation

Question 23
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Method of paying health care providers based on a lump sum amount paid prior to an agreed-upon time period:

a.
Capitation

b.
Case-based payments

c.
Global Budget

d.
Fee-for-service

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The correct answer is:

Global Budget

Question 24
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The No Co-Payment policy will remain in effect in the provision of the following PhilHealth benefit packages during the transition period of shifting from No Balance Billing policy
to No Co-payment policy:

a.
All case rates and Primary Care Benefits

b.
All case rates and Z Benefits

c.
Z Benefits and COVID-19 benefits

d.
Z Benefits and Primary Care Benefits

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The correct answer is:

Z Benefits and COVID-19 benefits

Question 25
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 Question text
The following are the allowable expenses for the Special Health Fund, EXCEPT:

a.
Individual-based health services

b.
Health system operating costs

c.
Remuneration of all health workers

d.
Incentives for all health workers

e.
Population-based health services

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Remuneration of all health workers

Question 26
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Which of the following statements is incorrect?

a.
The Joint Memorandum Circular on Special Health Fund provided the minimum fund level that will be allocated for equity purposes.

b.
The Provincial/City Health Board Resolution on the Special Health Fund budget shall be deliberated, endorsed and approved by the Chairperson, Vice-Chairperson and a
majority of the members of the Board.

c.
The authorized signing officials for the disbursement of funds shall be based on RA No. 7160 (Local Government Code) and RA No. 11223 (Universal Health Care Act).

d.
All statements are correct.

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The Joint Memorandum Circular on Special Health Fund provided the minimum fund level that will be allocated for equity purposes.

Question 27
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Method of paying health care providers based on classifying cases into a group with the same characteristics in terms of diagnoses, procedures, and expected resource use:

a.
Case-based payments

b.
Global Budget
 c.
Fee-for-service

d.
Diagnosis-related groups

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The correct answer is:

Diagnosis-related groups

Question 28
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The management of the Special Health Fund is being monitored through the Local Health Systems Maturity Levels under the following P/CWHS characteristic:

a.
Information Management

b.
Strategic and Investment Planning

c.
Unified Governance of the Local Health Systems

d.
Financial Management

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The correct answer is:

Financial Management

Question 29
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The following serve as the bases of the Provincial and City Health Board for the planning and budgeting of the Special Health Fund:

a.
Local Investment Plan for Health and its corresponding Annual Operational Plans

b.
Contractual agreements with DOH and PhilHealth

c.
Municipal, city, and provincial resolutions on health strategies

d.
All of the above are correct.

e.
Only A and B are correct.

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The correct answer is:

Only A and B are correct.
Question 30
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The Special Health Fund shall be maintained at the following LGU levels that committed to integrate, EXCEPT:

a.
Component Cities

b.
Provinces

c.
Highly Urbanized Cities

d.
Independent Component Cities

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The correct answer is:

Component Cities