Paying For Health Care In America: Rising Costs And Challenges
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- The Evolution of Professional NursingThe Contemporary Image of Professional NursingThe Influence of Contemporary Trends and Issues on Nursing EducationNursing Licensure and CertificationTheories of Nursing PracticeNursing Research and Evidence-Based PracticePaying for Health Care in America: Rising Costs and ChallengesLegal Issues in Nursing and Health CareEthical and Bioethical Issues in Nursing and Health CareCultural Competency and Social Issues in Nursing and Health CareComplementary and Alternative HealingPalliative CareWorkforce Advocacy for a Professional Nursing Practice EnvironmentCollective Bargaining and Unions in Today’s WorkplaceInformation Technology in the Clinical SettingEmergency Preparedness and Response for Today’s WorldNursing Leadership and ManagementBudgeting Basics for NursesEffective Communication and Conflict ResolutionEffective Delegation and SupervisionStaffing and Nursing Care Delivery ModelsQuality Improvement and Patient SafetyHealth Policy and Politics: Get Involved!Making the Transition from Student to Professional NurseManaging Time: The Path to High Self-PerformanceContemporary Nursing Roles and Career OpportunitiesJob Search: Finding Your MatchThe NCLEX-RN Examination
Question 1
Free
Multiple Choice
An older adult client was admitted to the hospital with the condition classified as "pneumonia." Reimbursement was based on a predetermined fixed price. This classification system is referred to as:
Choose correct answer/s
diagnosis-related groups (DRGs).
subjective symptom management.
acuity classification system.
organized managed care.
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Question 2
Free
Multiple Choice
The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a _____ nurse.
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case management
quality assurance
utilization review
cost-control
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Question 3
Free
Multiple Choice
Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing:
Choose correct answer/s
hospital admission rates.
length of hospital stay.
outpatient services.
specialty groups.
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Question 4
Free
Multiple Choice
When reviewing the literature on the effects of Medicaid on health care for the poor, the nurse researcher found that the poor:
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have less access than even the uninsured.
receive many unnecessary treatments.
lack consistent providers.
abuse preventive services.
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Question 5
Free
Multiple Choice
Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as:
Choose correct answer/s
charity.
cost shifting.
price sharing.
governmental reimbursement.
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Question 6
Multiple Choice
A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement?
Choose correct answer/s
Health maintenance organization
Preferred provider organization
Fee-for-service arrangement
Philanthropic agency
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Question 7
Multiple Choice
In the triad of health care, which would be considered the third-party payer?
Choose correct answer/s
Client
Health care provider
Insurance company
Government agency that sets reimbursement rules for services
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Question 8
Multiple Choice
A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a _____ payment system.
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prospective
retrospective
diagnosis-related group
capitated
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Question 9
Multiple Choice
A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting. The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis:
Choose correct answer/s
the cost of caring for this client was $5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company.
although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee.
the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease.
the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.
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Question 10
Multiple Choice
A young mother has detected a lump in her breast, and because she lives at the poverty level, she is covered under Medicaid. This individual:
Choose correct answer/s
is more likely to participate in mammography screening than are individuals covered by private insurance.
has designated primary care and a specialist as sources of care.
will more likely wait to seek care and will require hospitalization for a mastectomy, which could have been avoided if care had been sought earlier.
has decreased access to health care when compared with the uninsured.
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Question 11
Multiple Choice
A client who is reading a newspaper asks, "This article about health care states that many providers of health care lack effectiveness. What is the difference between effectiveness and efficiency?" The nurse explains that:
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effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome.
effective refers to competence in clinical practice and efficiency describes quick completion of the task.
efficiency means wasting and meeting a minimum standard and effectiveness refers to taking all the time needed to exceed expectations.
efficiency refers to speed and effectiveness refers to the usefulness of the implementation.
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Question 12
Multiple Choice
A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services?
Choose correct answer/s
Prospective payment system
Retrospective payment system
Single-payer system
Capitation
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Question 13
Multiple Choice
In February 2010, Congress passed legislation to support universal health care for all Americans. At a local health fair, an individual asks about the difference between universal health care and a single payer system. The nurse explains the difference is that:
Choose correct answer/s
with universal health, one universal payer, usually the government, pays all expenses for health care.
single-payer systems offer health care only to eligible persons based on income.
single-payer systems rely on insurance companies to pay predetermined fees for services.
with universal health, one payer is responsible for all health care costs, providing health care to all citizens.
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Question 14
Multiple Choice
An elderly person, age 80, is finding it difficult to live alone and the family is considering long-term care. The elderly person is reasonably healthy, with only normal aging declines, and maintains a healthy appetite. All medications are administered orally and require only minimal assistance. She is financially secure with an income based on retirement from both the military and factory from her deceased husband and herself. The family contacts long-term care and is told that, based on this patient's information:
Choose correct answer/s
Medicare will cover the cost of stay since skilled services are required.
Medicaid is only for families with dependent children.
Medicare will pay for home health services should these additional services meet the needs of the individual.
Medicare will pay regardless of household income or financial status for nursing home care.
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Question 15
Multiple Choice
Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act (PPACA) based on religious beliefs that prohibit circumcision and blood transfusions. These individuals believe the PPACA is unconstitutional because it:
Choose correct answer/s
mandates that all U.S. and legal residents must secure health insurance.
replaces current Medicare and Medicaid plans.
requires all citizens to participate in offered preventive services.
prohibits use of health practices outside of Western medicine.
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Question 16
Multiple Choice
A nurse is newly employed by a state-owned hospital that provides health care insurance requiring a deductible paid by the employee with the majority of the premium cost covered by the employer. The insurance provided to the nurse is:
Choose correct answer/s
private health insurance.
a federal insurances program known as PPACA.
state-subsidized Medicaid insurance.
single-payer system coverage.
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Question 17
Multiple Choice
Health care is one of the major stories in newspaper and television and a group of nurses are interested in how the economy impacts their nursing practice. The group critiques the relationship between contemporary economic trends and professional nursing practice and finds:
Choose correct answer/s
the implementation of the DRG system led to the nursing shortage since cost of nursing care is not billed.
nursing care is focused on technologically advanced acute care rather than preventive, patient-centered care.
with pay for performance, nurses have a significant effect on the quality of patient outcomes by reducing errors and providing care based on best practices.
economic issues have little or no impact on nursing practice.
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Question 18
Multiple Choice
A patient is eligible to change health care providers and insurance and asks, "I am interested in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would support these activities rather than just pay for services when I am sick"? Which, if any, health insurance plan would best meet the needs of this patient?
Choose correct answer/s
Health Maintenance Organization (HMO).
Fee for Service.
Preferred Provider Organization (PPO).
None, because health insurance plans currently cover only disease management, not preventive care.
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Question 19
Multiple Choice
A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women's health specialist because the primary care physician did not order the referral or the mammogram. Which type of insurance plan adheres to this type of payment system?
Choose correct answer/s
Fee for Service
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Point of Service (POS)
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Question 20
Multiple Choice
A patient wants to reduce health care costs by being a model for making wise decisions that both promote health and reduce cost. Which statement by the patient would indicate a need for further teaching?
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"I will ask for the brand name drug Tylenol rather than acetaminophen since it works better and I won't be sick as long."
"I looked up urinary tract infection prevention on the Internet."
"I had my weight, body fat, and blood sugar measured at a local health fair."
"My allergies are really bothering me. I spoke to the pharmacist, who recommended an over-the-counter antihistamine."
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