Question 1

During a lively class discussion on health care rationing, several students indicate that they find this upsetting. What is the best response from the instructor?

Accepted Answer

When rationing is based on social justice principles, it is a rational, fair, and equal distribution of resources according to a clinical need or potential for effectiveness and is not based on income or where one lives. It is based on the needs of the general population. Rationing is influenced by the economy and the past methods by which health care was provided, mainly only to those who could afford it. Rationing may also jeopardize the well-being of others, especially those with limited resources. Advances in knowledge and technological capabilities compound rationing decisions.

Question 2

The community health nurse is concerned for the local community with the raising health care costs. The nurse recognizes that managed competition is a potential solution, based on which factor?

Accepted Answer

Managed competition ideally would promote cost containment and universal access to health care. Governmental regulations and control would still be present as would insurance companies. Managed care would encourage consumers to make responsible choices.

Question 3

A public health nurse is asked by a group of students why they should choose public health nursing as a career focus. What is the best response by the public health nurse?

Accepted Answer

Public health nurses can lead the effort in making health care more accessible to all citizens. They focus on both health care and illness, striving to help everyone who needs health care. Financial support is available in both sectors from various sources. Public health nurses can find positions in all sectors-both public and private, nation and internationally, depending on where they wish to service.

Question 4

Health care reform has brought changes to public health nursing that can benefit the community as a whole. How might the public health department clinics respond as ACA increases coverage of individuals throughout the communities?

Accepted Answer

As more people are covered by ACA, public health department clinics may scale down or chose to claim reimbursement from private and public insurance. A greater number and variety of services are offered through public health agencies as private tend to specialize and focus on specific needs. Public health departments already assist with community health assessments by providing data such as birth rates, mortality rates, and incidence of communicable diseases in the community.

Question 5

A new graduate is exploring various options in public health nursing employment. The nurse recognizes a major difference between a rural and metropolitan setting is determined by which factor.

Accepted Answer

The structure of the local health department varies in complexity with the setting. Rural and small urban agencies need a simple organization, whereas large metropolitan agencies require more complex structures to support the greater diversity and quantity of work. Each location must follow and comply with the same federal and state legislation. Although each facility will have different leaders, that is not the major difference.

Question 6

The public health nurse recognizes that there are various resources available to the community for financing health care and providing services, many that are influenced by legislation. An act passed in the 1990s resulted in which major adjustment for Medicaid participants?

Accepted Answer

In 1997, mandates in the Balanced Budget Act resulted in Medicaid moving to a managed care concept in an attempt to control costs. This did not decrease the number of qualified participants nor did it affect the reimbursement rates. Reimbursement continues to be quite slow and has led to a decrease in providers currently participating; however, this has occurred over time and is related to more than just this one piece of legislation.

Question 7

A nurse is exploring the options of employment as an international public health nurse. If the nurse desires to assist others who are being denied health care, which is the best option?

Accepted Answer

Doctors without Borders is an international, neutral organization that sends emergency medical assistance to people in need due to war, epidemics, disasters, or denial of health care. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) goal is to assist people in forming peaceful and inclusive societies. They also promote sports, social integration, health, and education without regard to geographical borders of social classes. The U.S. Agency for International Development (USAID) is the lead U.S. government agency that works to end extreme global poverty and enable resilient, democratic societies to realize their potential. The Pan American Health Organization (PAHO) is the central coordinating organization for public health in the Western Hemisphere. They disseminate epidemiologic information, provide technical assistance, finance fellowships, and promote cooperative research and professional education.

Question 8

The nurse recognizes that the financial means of individuals often determines the amount of health care received. As health care has improved, the costs have increased. Which factor has contributed the most to rationing over the recent years?

Accepted Answer

Societal and medical advances have increased life expectancy and improved national welfare, but as spending continued to consume more and more of the GDP, more people have questioned if the costs outweighed the benefits. The other choices have contributed some to the situation; however, by increasing life expectancy, people are living longer resulting in more people being around to need the health care, as well as more individuals with chronic conditions that need care.

Question 9

A nurse is reviewing a client's health plan before the office visit. The client has a high-deductible health plan. Which best summarizes how this plan works?

Accepted Answer

High-deductible health plans are favored in small and large sized companies that often have saving plan options. The plan has higher deductibles and out-of-pocket maximum limits. Once these deductibles are met, the plan pays 100% of in-network health care. The plan allows for money to be set aside pre-taxed to be used for health care costs. Health Maintenance Organizations (HMOs) plans require all employees go to network providers to get medical care and services. HMOs will not cover out-of-network care except in an emergency. A Preferred Provider Organization (PPO) is a network of health care providers that provides its members with multiple choices regarding health care and health care providers. It offers the flexibility to use providers both in-network and out-of-network.

Question 10

A nurse is presenting information regarding the various reports from the Institute of Medicine (IOM) and their implications for public health to a group of students. At the end of the presentation, the nurse asks the students to name the IOM report that focuses on nursing's role in health care. Which response from the students would indicate to the nurse that the teaching has been successful?

Accepted Answer

There are several publications regarding public health that have been conceived by the Institute of Medicine. The one publication relevant to nursing and nursing education is The Future of Nursing: Leading Change, Advancing Health, which expresses the importance of nursing's role in achieving the vision for health care in PPACA and recommends strategies to improve nursing education, provides opportunities for leadership, and allows the scope of nursing practice to match nurses' education and training. The Future of Public's Health in the 21st century calls for expanding the responsibilities of the public health system beyond governmental agencies to include private and nongovernmental entities. For the Public's Health: Investing in a Healthier Future noted the need for additional focus on population-based prevention and federal spending on public health to be doubled. To Err is Human focuses on the extent of deaths due to medical errors in hospitals and calls for increased education about systems that promote safety, mandatory reporting of medical errors, and development of safety standards.

Question 11

A nurse is interviewing a client who recently visited the emergency department for an upper respiratory infection. The client states that the "hospital bill is more than my other hospital bill from a 2-day operation 1 year ago". Which is the statement the nurse uses in teaching the client about health care economics?

Accepted Answer

With health insurance companies and managed care, different prices are often paid for the same service, and consumers have little information as to the costs. Health care purchases are not easily understood. Health care is an "opaque market" that keeps consumers in the dark about actual costs of services and medications due to confidential negotiations, discounts, and rebates. Nurses need to teach clients about this and focus on health promotion to reduce unnecessary hospitalizations. The emergency department care is not more expensive than hospital floor care. A different number of medications is not the sole contributor to the cost but may be one of the factors that is negotiated. Asking a question is not appropriate when informing a client about the supply and demand of health care economics.

Quiz 6: Structure and Economics of Communitypublic Health Services