Deck 21: Economic and Quality Concerns

Question 1

The Joint Commission:

A) determines accreditation policies for not-for-profit organizations.
B) determines rights and responsibilities of health-care consumers and providers.
C) selects standards by which educational institutions are evaluated.
D) sets standards by which health-care quality is measured.

Answer 1

sets standards by which health-care quality is measured.

Question 2

In order to control health-care costs, the consumer can:

A) decide never to file a medical lawsuit.
B) make sure that his or her provider is within close proximity.
C) shop around for lower cost quality health care.
D) work with managed care companies supplying health-care services.

Answer 2

shop around for lower cost quality health care.

Question 3

Which of the following is the greatest factor contributing to the rise in health-care costs?

A) Changing economic conditions
B) Health insurance premiums
C) Latest technological services
D) Unemployment rates

Answer 3

Latest technological services

Question 4

The Child Health Insurance Program (CHIP) is part of which program/plan?

A) Indemnity insurance
B) Managed care
C) Medicaid
D) Medicare

Question 5

An exclusive provider organization (EPO) requires that members:

A) accept responsibility for health-care cost containment.
B) identify their preferred provider coverage.
C) Obtain health-care services within a particular network.
D) Pay a fixed monthly fee without employer compensation.

Question 6

Mary, a 76-year-old female receiving Medicare benefits, was recently diagnosed with diabetes and hypertension. She is taking medications by mouth for her diabetes and hypertension and is also receiving insulin injections for her diabetes. Which of the following affects Mary's access to health care?

A) Disease diagnosis
B) Health-care services co-payment
C) Immigration status
D) Prescription drug affordability

Question 7

Medicare and Medicaid cover all prescription costs for the very young and the elderly.

Question 8

Reimbursement for delivery of health-care services has not changed in the last 10 years.

Question 9

Marissa, a 42-year-old female, has been experiencing chronic back pain. She sees her health-care provider, who tells her that she needs to have expensive diagnostic tests done to determine the cause. Because Marissa has no health insurance and does not qualify for Medicaid, her health-care provider gives her a prescription for pain control and sends her home. Which of the following roles should the nurse assume in Marissa's case to assure the best outcome for her?

A) Advocate
B) Coordinator of care
C) Emotional support coach
D) Professional consultant

Question 10

Managed care organizations provide access to quality health care at a reasonable cost.

Question 11

Which of the following entities does not reimburse health-care costs to providers of health-care services?

A) Indemnity insurance plans
B) Medicaid
C) Medicare
D) State Health Department

Question 12

Of the following, select one of the principles to which the American Nurses Association (ANA) is committed:

A) Acute care services are preferable to community-based services.
B) Health care is a basic right.
C) Health policies should be focused on the health-care institutions.
D) Multi-payer health-care services are desirable health-care reform options.

Question 13

By 2019, national health-care costs are expected to reach:

A) $2 billion.
B) $20 billion.
C) $4.5 trillion.
D) $40 trillion.

Question 14

In a capitation health-care plan, the hospital's goal is to provide care for less than what the set fee is.

Question 15

Factors contributing to an increase in health-care costs include:

A) health-care professional surplus.
B) health insurance company losses.
C) in-network health-care organizations.
D) uninsured consumers of health-care services.

Question 16

The prospective payment system (PPS) is based on the concept that:

A) reimbursement to hospitals is not a major problem.
B) similar medical diagnoses result in the same hospitalization costs.
C) standards of practice can be set.
D) total patient care can be delivered in a safe and holistic manner.

Question 17

Which of the following is a factor affecting health-care costs?

A) Consumer knowledge of health-care options
B) Hospital availability in rural areas
C) In-network provider services
D) Lack of options for health-care services

Question 18

Which of the following emphasizes health promotion and disease prevention?

A) Indemnity health insurance plans
B) Managed care organizations
C) Medicaid
D) Medicare

Question 19

The government's Medicare and Medicaid programs were created to assist:

A) children and the elderly.
B) health insurance companies.
C) managed care plans.
D) migrant populations.

Question 20

Lawsuits related to health-care services have had a dramatic effect on health-care costs.

Question 22

Texas is the only state in the nation that has CHIP.

Question 25

The American Nurses Association (ANA) is committed to providing managed care plans.

Question 28

Children are eligible for Medicare coverage.