Question 1

The population health nurse is explaining to a patient about the type of health services that are paid for by a third party such as private health insurance. What is the nurse explaining to this patient?

Accepted Answer

3. Third party payment is made through reimbursement for services rendered. Prospective payment is most commonly utilized today, with payment given at a predetermined fixed rate for a specific set of services. Retrospective reimbursement was formerly the primary form of third party payment for services rendered based on the cost of the services. Rising health prices and spiraling insurance health care costs now limit this form of reimbursement because some services were given solely for reimbursement purposes and not for health reasons. Deductible payments are those payments the person makes out of pocket until a limit is reached where the insurance company will take over responsibility for payment. Capitation refers to a prospective payment system that pays health plans or providers a fixed amount per enrollee per month for providing a defined set of health needs.

Question 2

The population health nurse is preparing material for an educational seminar on the differences between Medicare and Medicaid. What should the nurse include in this teaching?

Accepted Answer

4. As originally legislated, Medicare provided partial coverage of health services to the population who reached the age for receiving Social Security benefits at age 65. Medicaid was established to provide health services to the medically needy, categorically needy, and certain special groups who fell outside of the mainstream for any health care services. Medicare does not cover all health care services, nor does Medicaid. While Medicare traditionally does not cover preventive care, it has started to provide limited coverage of preventive services, as does Medicaid in such services as immunizations. Funding for Medicare comes from the federal level. Medicaid funding is administered by the states but with block grants given by the federal government.

Question 3

The population health nurse is reviewing the State Children's Health Insurance Programs (SCHIP) with a mother who has seven children. During this conversation the nurse explains that this program was established by Congress to provide health insurance coverage for low-income children whose parents did not have insurance coverage or who did not qualify for Medicaid benefits and is administered by the state. What process is the nurse reviewing that highlights the transfer of federal oversight and responsibility to the states for this program?

Accepted Answer

1. The establishment of SCHIP was an attempt by the federal government to provide for health services for low-income children. The federal government gave the states the option of expanding existing Medicaid programs or creating separate Children's Health Insurance Programs (CHIP). This is devolution, the transfer of responsibility for an area from federal to state government. It is not shared responsibility, block grant funding, or health care innovation.

Question 4

The population health nurse learns that the state of practice received a block grant to address a health problem. Which problem should the nurse advocate to receive this grant?

Accepted Answer

4. A block grant is a sum of money given to states by the federal government, intended to be used by each state as it sees fit but within broadly defined parameters. All choices could be potential uses for a block grant; however, opening statewide immunization centers to provide immunization coverage is the better choice because it represents a primary prevention mechanism that will protect the population from communicable diseases and improve health status. It will also not use additional health care services. Conducting research and developing education programs are appropriate, but the immunization program is an active direct-services approach. Increasing Medicaid coverage is not an appropriate use for a block grant because federal and state guidelines address Medicaid eligibility.

Question 5

The population health nurse providing care in an economically disadvantaged city is aware of many people receiving their health care through charity systems that are set up by local physicians. The nurse is concerned because this practice can contribute to rising health care costs by:

Accepted Answer

4. Reimbursement is limited or nonexistent in charity care, so people who utilize this system tend to be uninsured or underinsured. Uncompensated care can lead to cost shifting, where these costs are passed along to those who are able to pay, either out of pocket or through insurance. The consumer price index is not dependent on uncompensated care. Traditionally there is decreased use of technology for underinsured and uninsured populations. There is a finite number of hospital beds, which is unaffected through utilization.

Question 6

The population health nurse is attending a community town hall meeting where an elected official is discussing the importance of extending tax cuts for the upcoming fiscal year. What should the nurse consider as the impact of these cuts on health care? (Select all that apply.)

Accepted Answer

1. Tax cuts maintain expenditures while at the same time reducing revenues that could fund them. Although tax cuts and low interest rates will stimulate the economy in the short run, they are likely to cause a long-term imbalance leading to increasing deficits, lower rates of national savings, higher interest rates, and a slowed economy as well as reductions in government-supported services. All of these factors will lead to a greater scarcity of health resources and more severe effects on the health of the population. Tax cuts will have no impact on chronic diseases, the number of care providers, or access to health care services.
5. Tax cuts maintain expenditures while at the same time reducing revenues that could fund them. Although tax cuts and low interest rates will stimulate the economy in the short run, they are likely to cause a long-term imbalance leading to increasing deficits, lower rates of national savings, higher interest rates, and a slowed economy as well as reductions in government-supported services. All of these factors will lead to a greater scarcity of health resources and more severe effects on the health of the population. Tax cuts will have no impact on chronic diseases, the number of care providers, or access to health care services.

Question 7

During a home visit the population nurse learns that the family's father has recently lost his job, and the mother continues to be unemployed but takes care of the family's five children. The mother is concerned because charitable organizations are not eager to provide resources to help the family as they have in the past. What should the nurse explain as the primary reason for charitable organizations to have less funds to distribute?

Accepted Answer

2. Charitable giving tends to decrease during hard economic times and frequently does not keep pace with inflation and the cost of providing charity care. In addition, many nonprofit organizations are faced with growing demands for assistance during economic downturns stretching their resources even further. Charitable organizations are not going out of business. There is no information to support that the family has received maximum support or the parents' ability to work is negatively impacting the response from charities.

Question 8

The population health nurse is reviewing information to include in a presentation on the economics of health care. Which statements should the nurse include in this presentation? (Select all that apply.)

Accepted Answer

2. The higher the educational level, the higher the societal productivity, which leads to better health outcomes through informed health choices. Health affects the national economic welfare, so an employed and healthy workforce is necessary for an economically healthy society. Chronic illness in a stable workforce impacts productivity, as people with chronic diseases may take more time off for the chronic illness. Lost productivity from illness has a direct effect on societal outcomes. Health insurance does not guarantee a healthy workforce as the insurance may be limiting in coverage or expensive to purchase.
3. The higher the educational level, the higher the societal productivity, which leads to better health outcomes through informed health choices. Health affects the national economic welfare, so an employed and healthy workforce is necessary for an economically healthy society. Chronic illness in a stable workforce impacts productivity, as people with chronic diseases may take more time off for the chronic illness. Lost productivity from illness has a direct effect on societal outcomes. Health insurance does not guarantee a healthy workforce as the insurance may be limiting in coverage or expensive to purchase.

Question 9

A community member tells the population health nurse that a new health insurance program expects the patient to pay deductibles and other costs. What other type of cost sharing should the nurse explain to the individual?

Accepted Answer

2. Co-payments are out-of-pocket payments that the insured has agreed to pay as part of the contract with the insurance provider. Typically, co-payments are made with each health service visit. Out-of-pocket payments as complete payment are made for services not covered under an insurance plan. CPT codes refer to health services coded for billing purposes and reimbursement by providers and do not involve direct payment from the insured person. Capitation does not require co-payment.

Question 10

The population health nurse is assisting with a booth at a health fair to help community members sign up for health insurance. For which reasons should the nurse promote the importance of having health insurance? (Select all that apply.)

Accepted Answer

4. Having health insurance is associated with having a regular source of care and a greater likelihood of receiving health promotive services. Health disparities address the differences in measures of health status or access to health services, which have been associated with insurance status as well as other factors. Having health insurance does not lessen the difficulty in obtaining health care because there may be restrictions on the type of health insurance a person has. Not all who are employed full-time can afford health insurance as their incomes may be within the gap that is between federal coverage but too expensive to purchase privately.
5. Having health insurance is associated with having a regular source of care and a greater likelihood of receiving health promotive services. Health disparities address the differences in measures of health status or access to health services, which have been associated with insurance status as well as other factors. Having health insurance does not lessen the difficulty in obtaining health care because there may be restrictions on the type of health insurance a person has. Not all who are employed full-time can afford health insurance as their incomes may be within the gap that is between federal coverage but too expensive to purchase privately.

Question 11

The population health nurse is participating in a discussion about the number of physicians in the United States being able to meet health care needs. What should the nurse identify as the primary reason for physicians contributing to escalating health care costs?

Accepted Answer

2. Specialists have higher reimbursements and fees, and represent two-thirds of the physician workforce in the United States; as such, specialists contribute to escalating health care costs. Nationwide hospital beds have not decreased. While there is a large segment of the population who is uninsured, this is not reflected in the number of physicians and there is no evidence that physicians are necessarily prescribing more expensive medications.

Question 12

An older community member is concerned about the rising cost of prescription medications. Which part of Medicare should the population health nurse review with this individual?

Accepted Answer

4. Part D is the Medicare Prescription Drug Plan, which was designed to provide drug subsidization for those enrolled in Medicare. Part C, which is the Medicare Advantage permits Medicare enrollees to exercise similar health care options as others in the population. Part B covers medically necessary provider services not covered under Part A. Part B coverage is optional and requires an additional payment premium. Part A covers medically necessary hospitalization, skilled nursing facility (SNF) care, some home health care, hospice, and blood products administered in in-patient facilities.

Question 13

The population health nurse is creating a tool to assess the economic status of a small rural neighborhood. What should the nurse include in this tool? (Select all that apply.)

Accepted Answer

1. When assessing economic status of a population the nurse should focus on the number of members who are unemployed, the average income of the members, the number of members who are at poverty level, and the ways in which health care is funded by the members. Although important, education level is not included in an assessment of economic status for a population.
2. When assessing economic status of a population the nurse should focus on the number of members who are unemployed, the average income of the members, the number of members who are at poverty level, and the ways in which health care is funded by the members. Although important, education level is not included in an assessment of economic status for a population.
3. When assessing economic status of a population the nurse should focus on the number of members who are unemployed, the average income of the members, the number of members who are at poverty level, and the ways in which health care is funded by the members. Although important, education level is not included in an assessment of economic status for a population.
5. When assessing economic status of a population the nurse should focus on the number of members who are unemployed, the average income of the members, the number of members who are at poverty level, and the ways in which health care is funded by the members. Although important, education level is not included in an assessment of economic status for a population.

Question 14

The population nurse becomes aware of an increase in social instability in one neighborhood. This instability can affect societal health because it can lead to:

Accepted Answer

1. Factors that have contributed to increasing health care spending include an aging population. An aging population contributes to greater demand for and use of services, particularly as the prevalence of chronic diseases with high costs for disease management increases in older age groups. The size of the older population relative to other age groups in the United States has increased consistently over the last several decades. People over age 65 consume a large portion of the health care services provided each year. The birth rate in the United States is not declining and while there are concerns about adolescent mental health problems and the rise of childhood asthma, these do not represent immediate priority concerns regarding the economic health status.

Quiz 6: Economic Influences on Population Health