Question 1

Which of the following is considered the first national health insurance plan in the United States?

Accepted Answer

The Marine Hospital Service, established in 1798, provided healthcare for sailors and was the first national healthcare system in the United States. Medicare and Medicaid were established in 1965 and the HMO Act was passed in 1973, all of which came after the Marine Hospital Service.

Question 2

Which of the following statements about the reimbursement of health services for nurses is accurate?

Accepted Answer

Nurse practitioners and clinical nurse specialists are reimbursed for Medicare Part B services, which includes outpatient services, preventative care, and durable medical equipment. This reimbursement includes services such as health assessments, physical examinations, and ordering diagnostic tests. While nursing care is not typically separated from medical care in determining hospital service costs, nurse practitioners and clinical nurse specialists may be reimbursed for their services separately from physicians in outpatient settings.

Question 3

The method of paying an organization whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client is called:

Accepted Answer

Prospective reimbursement is the payment method where the third-party payer determines the amount to be paid for a specific service before the service is provided to the patient. This type of reimbursement is often used for inpatient hospital care. Retrospective reimbursement, on the other hand, is payment made after the services have been provided based on the actual cost of the services. Fee-for-service involves payment for each specific service provided to the patient, while capitation involves payment based on the number of patients served by a healthcare provider or organization, rather than the services provided.

Question 4

The method whereby fees for the delivery of health care services in an organization are set after services are delivered is called:

Accepted Answer

Retrospective reimbursement is the method whereby fees for the delivery of health care services are set after services have been delivered. This system is also known as "payment after the fact." The reimbursement is based on the actual cost of services provided during a specific period. The health care provider submits a bill for services rendered, and the payer reviews the bill and reimburses the provider for the services rendered. This may be done on a cost basis or on negotiated rates. Prospective reimbursement, on the other hand, is a method of setting fees for health care services before the services are delivered. Fee-for-service is a method of payment where providers charge separately for each service they provide. Capitation is a method of payment where providers are paid a fixed amount per member per month, regardless of the amount or type of services provided.

Question 5

Of the following four major factors, which has the greatest effect on health?

Accepted Answer

Personal behavior and lifestyle choices such as tobacco use, poor diet, lack of physical activity, and drug and alcohol abuse are responsible for 40% of premature deaths in the US alone. This factor has the most significant impact on health compared to the other factors mentioned. Environmental factors, healthcare systems, and human biology also impact health, but to a lesser extent than personal behavior and lifestyle.

Question 6

The economic theory used by nurses who work with aggregates would be:

Accepted Answer

Nurses working with aggregates focus on community health, which involves understanding and influencing policies and programs at a broader level, aligning with macroeconomic theory.

Question 7

Which of the four developmental stages in the U.S. health care delivery system exhibited a shift away from infectious diseases?

Accepted Answer

The third stage (1945 to 1984) of the U.S. health care delivery system exhibited a shift away from infectious diseases due to the development of antibiotics and vaccines, which led to a decline in the incidence of infectious diseases.

Question 8

Medicare Part B is available to:

Accepted Answer

Medicare Part B is available to eligible people who are paying a monthly premium. This includes individuals who are 65 or older, as well as those under 65 who have certain disabilities or end-stage renal disease. It is not specifically for the medically indigent, as that would fall under Medicaid.

Question 9

Medicare Part A provides payment for:

Accepted Answer

Medicare Part A provides payment for extended care facilities such as nursing homes, skilled nursing facilities, and inpatient hospital stays. It does not cover laboratory services, outpatient health care, or ambulance transportation, which are covered by Medicare Part B.

Question 10

Which of the following is used to pay physicians and other practitioners a set amount to provide care to a given client or group of clients for a set period of time and amount of money?

Accepted Answer

Capitation is a payment method where the healthcare provider is paid a fixed amount per patient per unit of time, regardless of the actual number or nature of services provided. This incentivizes providers to focus on preventive care and efficiency in treating patients to maximize profits while minimizing costs.

Question 11

A characterization of the fourth developmental stage of the health services delivery framework is:

Accepted Answer

The fourth developmental stage of the health services delivery framework is characterized by a heavy reliance on technology for patient care, reflecting advancements in medical technology and its integration into healthcare practices.

Question 12

Health care spending outpaces increases in the gross domestic product. Factors that influence health care costs include which of the following. Select all that apply.

Accepted Answer

Technology and intensity in healthcare contribute to the increasing costs, coupled with the aging population and the prevalence of chronic illnesses. HIPAA, on the other hand, is a regulation that aims to protect patients' health information and does not directly impact healthcare costs.

Question 13

Medicaid provides financial assistance to pay for medical services for:

Accepted Answer

The answer of Medicaid provides financial assistance to pay for...

Question 14

Federal intervention to protect health insurance coverage for workers and families following a job change or loss is called:

Accepted Answer

The correct answer is Health Insurance Portability and Accountability Act (HIPAA), which includes provisions to protect health insurance coverage for workers and families when they change or lose their jobs. HIPAA restricts insurers from denying coverage to individuals with pre-existing conditions or basing premiums on health status. It also allows individuals to continue their health insurance coverage under their previous employer's plan for a set period of time after leaving that job.

Question 15

Which of the following statements about the Medicare program is accurate?

Accepted Answer

Part A of Medicare provides coverage for hospitalization, hospice care, and skilled nursing facility care.

Answer: None of the above 
 None of the statements are completely accurate. Part A does not require a monthly premium for most people, but Part B does require a premium. Part B covers medically necessary services and equipment, but not home health services or extended care facilities. Finally, Part B is not available without cost to all elderly people who have paid social security taxes, as income-based premiums can apply.

Question 16

Evaluating a program to prevent teen pregnancy, the gained or increased financial income, the improvements in the community attributable to the program, or costs that would result if the program was not given is an example of which of the following?

Accepted Answer

Evaluating the gained or increased financial income, improvements in the community, and costs that would result if the program was not given are all components of a cost-benefit analysis. This type of analysis compares the costs of a program to its benefits in order to determine if it is worth the investment.

Quiz 5: Economics of Health Care Delivery