National Health Accounts — MCQs
Based on healthcare utility values and life expectancy, which of the following measures can be calculated? Consider a scenario where the average life expectancy for a woman in Japan is 87 years, and there is an increase in life expectancy due to healthcare advancements.
In implementation of a health programme, best thing to do is -
In Ayushman Bharat under School Health Services, which of the following is not included?
Most basic level of Health Care System in India -
Which of the following procedures is not typically covered by the National Programme for Control of Blindness (NPCB) for reimbursement of surgery done by a non-governmental organization (NGO) eye hospital?
A good indicator of the availability, utilization, and effectiveness of healthcare services in a country is
Ayushman Bharat is
Which committee is responsible for making a plan for village health under NHM
The most comprehensive indicator of cost-effectiveness analysis is
Identify the index?
National Health Accounts Indian Medical PG Practice Questions and MCQs
Question 1: Based on healthcare utility values and life expectancy, which of the following measures can be calculated? Consider a scenario where the average life expectancy for a woman in Japan is 87 years, and there is an increase in life expectancy due to healthcare advancements.
- A. HALE
- B. DALY
- C. DFLE
- D. QALY (Correct Answer)
Explanation: ***QALY*** - **Quality-Adjusted Life Years (QALYs)** combine the length of life with the **quality of life** lived, taking into account healthcare utility values (e.g., from 0 for dead to 1 for perfect health). - An increase in life expectancy due to healthcare advancements, coupled with assumed utility values, directly enables the calculation of QALYs gained or lost. *HALE* - **Health-Adjusted Life Expectancy (HALE)** is a measure of the average number of years that a person can expect to live in "**full health**" by adjusting for years lived in less than full health due to disease or injury. - While it incorporates health status, it specifically focuses on time lived in full health rather than the utility-weighted quality of life over the entire lifespan as QALYs do. *DALY* - **Disability-Adjusted Life Years (DALYs)** measure the total number of healthy years lost due to disease, disability, or premature death. - DALYs are a measure of disease burden, quantifying years lost, whereas QALYs are a measure of health gains or health states. *DFLE* - **Disability-Free Life Expectancy (DFLE)** measures the expected number of years an individual will live without disability. - While it considers the absence of disability, it does not incorporate the concept of "utility values" or varying degrees of health-related quality of life beyond a binary disabled/non-disabled state, as QALYs do.
Question 2: In implementation of a health programme, best thing to do is -
- A. Discussion with leaders in community and implement accordingly
- B. Discussion with people in community and decide according to it
- C. Discussion and decision taken by the health ministry regarding implementation
- D. Discussion with doctors in PHC and implement accordingly (Correct Answer)
Explanation: ***Discussion with doctors in PHC and implement accordingly*** - **Primary Healthcare (PHC) doctors** possess critical hands-on knowledge of common health issues, local demographics, and daily health challenges faced by the community. - Their involvement ensures the program is **practically viable** and tailored to the specific needs and resources available at the grassroots level for effective implementation. *Discussion with leaders in community and implement accordingly* - While engaging community leaders is important for acceptance and dissemination, they may lack the **medical expertise** required to design effective and clinically sound health interventions. - Relying solely on leaders might lead to programs that are **socially acceptable but not medically optimal** or comprehensive. *Discussion with people in community and decide according to it* - Involving the community is crucial for program adherence and understanding local needs, but **laypersons** may not have the necessary medical knowledge to make informed decisions about complex health interventions. - Their input is valuable for relevance and acceptance, but medical and public health expertise is required for program design and implementation to ensure **efficacy and safety**. *Discussion and decision taken by the health ministry regarding implementation* - The health ministry sets policies and provides overall strategic direction, but they often lack direct, **on-the-ground understanding** of specific local health issues and implementation challenges. - A top-down approach without involving local healthcare providers can lead to programs that are **not feasible** or effective in the local context.
Question 3: In Ayushman Bharat under School Health Services, which of the following is not included?
- A. Health check-up/screening
- B. Albendazole provision
- C. Monthly Iron Folic Acid Supplementation
- D. Providing free spectacles (Correct Answer)
Explanation: ***Providing free spectacles*** - Under Ayushman Bharat School Health Services and RBSK (Rashtriya Bal Swasthya Karyakram), while **vision screening** is universally implemented, the provision of **free spectacles** is not uniformly guaranteed across all states and depends on fund availability and state-level implementation. - The primary focus remains on **screening and referral**, with spectacle provision being supplementary rather than a core mandated service compared to the other interventions listed. - Unlike the other three services which are universally delivered, free spectacles provision shows **geographic and implementation variability**. *Health check-up/screening* - **Comprehensive health check-ups** and screenings are a mandatory core component of the Ayushman Bharat School Health Program implemented uniformly across all states. - This includes screening for common conditions like **vision problems**, **hearing impairments**, **dental issues**, and growth monitoring. *Albendazole provision* - The administration of **Albendazole** for biannual deworming is a standard, universally implemented practice under the National Deworming Day initiative integrated with School Health Programs. - This is part of a broader strategy to improve the **nutritional status** and overall health of school-going children. *Monthly Iron Folic Acid Supplementation* - **Iron Folic Acid (IFA) supplementation** through the Weekly Iron Folic Acid Supplementation (WIFS) program is a key mandated intervention to combat **anemia** among adolescents (10-19 years). - This is universally implemented through School Health Services and directly contributes to improving **cognitive function** and physical health of students.
Question 4: Most basic level of Health Care System in India -
- A. Primary health care (Correct Answer)
- B. Secondary health care
- C. Tertiary health care
- D. All are same
Explanation: ***Primary health care*** - **Primary health care** is the first point of contact for individuals with the health system, providing essential and accessible healthcare services - In India, it is delivered through **sub-centers** (the most peripheral unit) and **primary health centers (PHCs)**, forming the **most basic and widespread layer** of the healthcare system - This represents the foundational level of care, focusing on preventive, promotive, and basic curative services *Secondary health care* - **Secondary health care** involves more specialized services, typically provided in district hospitals or community health centers (CHCs) - It serves as a referral point from primary care for patients requiring diagnostics, specialist consultations, or inpatient care - This is a **higher level of care** than primary, not the most basic level *Tertiary health care* - **Tertiary health care** offers highly specialized and advanced medical care, often involving complex procedures, specialized investigations, and management of rare or severe diseases - Provided in medical colleges, research institutes, and super-specialty hospitals - This represents the **highest and most advanced level** of the healthcare system, not the most basic *All are same* - This option is incorrect because the Indian healthcare system is structured in a **hierarchical manner** with distinct levels - Each level (primary, secondary, and tertiary) provides different services, varying in complexity, specialization, and accessibility - Primary care is clearly the most basic level, while secondary and tertiary represent progressively higher levels of specialization
Question 5: Which of the following procedures is not typically covered by the National Programme for Control of Blindness (NPCB) for reimbursement of surgery done by a non-governmental organization (NGO) eye hospital?
- A. Cataract surgery
- B. Pan retinal photocoagulation for diabetic retinopathy
- C. Syringing and probing of the nasolacrimal duct (Correct Answer)
- D. Trabeculectomy surgery
Explanation: ***Syringing and probing of the nasolacrimal duct*** - While important for lacrimal drainage issues, procedures like **syringing and probing** are generally considered minor and less vision-restoring compared to the major surgeries targeted by the **NPCB**. - The **NPCB** focuses on interventions for leading causes of blindness, primarily **cataract** and other significant vision-threatening conditions, which this procedure typically isn't. *Cataract surgery* - **Cataract surgery** is a cornerstone of the **NPCB's** efforts, as cataracts are the leading cause of reversible blindness. - Reimbursement for **cataract surgery** is a primary objective to improve access and reduce the burden of blindness. *Pan retinal photocoagulation for diabetic retinopathy* - **Diabetic retinopathy** is a major cause of preventable blindness, and **pan retinal photocoagulation (PRP)** is a key intervention to preserve vision. - The **NPCB** includes procedures for **diabetic retinopathy** management due to its significant public health impact. *Trabeculectomy surgery* - **Trabeculectomy** is a surgical procedure for **glaucoma**, which is another significant cause of irreversible blindness. - The **NPCB** includes interventions for **glaucoma** given its severe vision-threatening nature and the need for surgical management in many cases.
Question 6: A good indicator of the availability, utilization, and effectiveness of healthcare services in a country is
- A. Hospital bed occupancy rate
- B. DALY
- C. Maternal Mortality rate
- D. Infant mortality rate (Correct Answer)
Explanation: ***Infant mortality rate*** - The **infant mortality rate (IMR)** is widely recognized as a sensitive indicator of the overall health, socioeconomic conditions, and efficacy of a country's healthcare system. - A low IMR reflects good access to prenatal care, safe delivery practices, effective postnatal care, and strong public health interventions. *Maternal Mortality rate* - While the **maternal mortality rate (MMR)** reflects the quality of obstetric care, it primarily focuses on maternal health outcomes and not the broader accessibility and effectiveness of the entire healthcare system in the same comprehensive way as IMR. - It might not fully capture the quality of pediatric, preventive, or general primary care services. *Hospital bed occupancy rate* - **Hospital bed occupancy rate** indicates the utilization of available hospital resources but does not directly measure the effectiveness or overall accessibility of healthcare services. - It can be influenced by factors like hospital management and patient flow, which are only a part of the health system. *DALY* - **Disability-adjusted life years (DALY)** measure the total burden of disease, including years of life lost due to premature mortality and years lived with disability. - While it assesses health outcomes, DALY is a comprehensive measure of disease burden rather than a direct indicator of the availability, utilization, and effectiveness of healthcare services in a country.
Question 7: Ayushman Bharat is
- A. Health protection scheme (Correct Answer)
- B. Health practicing guidelines
- C. Health education program
- D. Health personnel training
Explanation: ***Health protection scheme*** - Ayushman Bharat is a **national health protection scheme** in India, aimed at providing affordable and accessible healthcare. - It consists of two major initiatives: the **Pradhan Mantri Jan Arogya Yojana (PMJAY)**, which provides health insurance coverage, and the creation of **Health and Wellness Centers (HWCs)**. *Health practicing guidelines* - While Ayushman Bharat promotes good health practices through its Wellness Centers, its primary function is not to establish or disseminate **medical practice guidelines**. - **Practicing guidelines** are typically developed by medical professional bodies or regulatory authorities. *Health education program* - Although health education is a component of the **Health and Wellness Centers** under Ayushman Bharat, the scheme's overarching goal is not solely an **educational program**. - Its main focus is on providing **financial protection** against catastrophic health expenditures and primary healthcare services. *Health personnel training* - While the implementation of Ayushman Bharat may indirectly lead to the need for more trained health personnel, it is not primarily a **training program** for healthcare staff. - Its core objective is to improve **healthcare access and affordability** for citizens.
Question 8: Which committee is responsible for making a plan for village health under NHM
- A. Village Health Sanitation and Nutrition Committee (Correct Answer)
- B. Village Health planning and management committee
- C. Rogi kalyan samiti
- D. Panchayat Health Committee
Explanation: ***Village health sanitation and Nutrition committee*** - The **Village Health, Sanitation and Nutrition Committee (VHSNC)** is the designated body under the National Health Mission (NHM) responsible for local health planning and resource management at the village level. - Its primary role is to promote community participation, address **local health needs**, and facilitate the implementation of health and nutrition programs. *Village Health planning and management committee* - This is not the officially recognized or structured committee name under the **National Health Mission (NHM)** for village-level health planning. - While reflecting similar functions, the specific nomenclature and mandate belong to the **VHSNC**. *Panchayat Health Committee.* - While panchayats play a crucial role in local governance and health initiatives, the dedicated committee for health planning under NHM is the **VHSNC**, not a general "Panchayat Health Committee." - The **VHSNC** is specifically constituted for health, sanitation, and nutrition, often with broader representation than just the panchayat members. *Rogi kalyan samiti* - **Rogi Kalyan Samitis** (Patient Welfare Committees) primarily operate at the **facility level** (e.g., district hospitals, Community Health Centers) to improve basic amenities and services for patients. - They are not responsible for comprehensive **village-level health planning** as described in the question.
Question 9: The most comprehensive indicator of cost-effectiveness analysis is
- A. Number of heart attacks avoided
- B. Cost per life year gained
- C. Number of life years gained
- D. QALYs gained (Correct Answer)
Explanation: ***QALYs gained*** - **Quality-Adjusted Life Years (QALYs)** is the most comprehensive measure in cost-effectiveness analysis as it accounts for both the quantity and quality of life - Combines years of life added with a utility score reflecting health-related quality of life during those years - Provides a holistic view that captures both mortality and morbidity benefits of interventions *Number of heart attacks avoided* - Specific to a single clinical outcome and does not account for other health benefits or adverse effects - While important for cardiovascular interventions, it is too narrow to serve as a comprehensive cost-effectiveness indicator - Does not capture broader impact on overall health, quality of life, or longevity *Cost per life year gained* - Focuses on the quantity (length) of life gained but does not consider the quality of those gained years - An intervention might add years of life that are of poor quality, which this measure cannot differentiate - Less comprehensive than QALYs as it misses the health status dimension *Number of life years gained* - Only considers the extension of life without incorporating health status or quality of life during additional years - Provides an incomplete picture as it treats all life years equally regardless of health state - A longer life with significant disability would be valued the same as healthy years
Question 10: Identify the index?
- A. Human developmental index (Correct Answer)
- B. POLI
- C. Human poverty index
- D. Multidimensional poverty index
Explanation: ***Human developmental index*** - The **Human Development Index (HDI)** is the correct answer as the diagram exactly represents its three core dimensions - HDI measures overall achievement in: **Health** (life expectancy at birth), **Education** (mean years of schooling and expected years of schooling), and **Living standards** (GNI per capita) - These are the standard components published by UNDP for calculating HDI - HDI is a summary measure of average achievement in key dimensions of human development *Human poverty index* - The Human Poverty Index (HPI) was an older measure that has been discontinued - HPI focused on deprivations rather than overall development achievements - The diagram shows development indicators (positive achievements), not deprivation indicators - HPI has been replaced by the Multidimensional Poverty Index (MPI) *POLI* - **POLI** (Physical Quality of Life Index) is a different index that uses infant mortality, life expectancy at age one, and literacy rate - The components shown in the diagram (mean years of schooling, expected years of schooling, GNI per capita) are not part of POLI - This is not a recognized standard index in current use *Multidimensional poverty index* - The **Multidimensional Poverty Index (MPI)** measures acute multidimensional poverty across health, education, and living standards - However, MPI uses **different specific indicators**: nutrition, child mortality, years of schooling, school attendance, cooking fuel, sanitation, drinking water, electricity, housing, and assets - The diagram shows HDI components (life expectancy, mean/expected years of schooling, GNI per capita), which are NOT the MPI indicators - MPI focuses on deprivations at the household level, while the diagram shows aggregate development measures
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