Deck 3: The United States Health Care System

Question 1

Which of the following is considered to be a responsibility of an insurance company?

A)Establishing guidelines for employees in hospitals
B)Establishing the rules of medical practice
C)Managing third-party reimbursement
D)Purchasing and managing hospitals and extended care facilities

Answer 1

Managing third-party reimbursement

Question 2

A community member asks a community/public health nurse,"How much progress has been made toward consolidating state health services into a single agency?" Which of the following statements would be accurate for the nurse to make?

A)"Incredible progress;about half the states have done so."
B)"Little progress;no state has completely done so."
C)"Some progress;about one third of the states have done so."
D)"Successful progress;most states have done so."

Answer 2

"Little progress;no state has completely done so."

Question 3

A client has been informed that his health care plan will be changing to a managed care model.How would the nurse best explain the goal of this model?

A)Managed care decreases consumer use of outpatient health care.
B)Managed care ensures maximum value received from resources used.
C)Managed care decreases patient satisfaction.
D)Managed care ensures provider satisfaction.

Answer 3

Managed care ensures maximum value received from resources used.

Question 4

A nurse is employed by the American Heart Association.What feature of this type of organization is unique?

A)Assisting with access to health care services
B)Promoting the use of inexpensive health care providers
C)Using creative approaches to solve health problems
D)Providing professional education to health care providers

Question 5

A community/public health nursing faculty member discusses with students the significant changes in the U.S.health care system.Why is this information important to discuss with this population?

A)Helps orient students to their options for health insurance
B)Helps students understand health behaviors
C)Helps students determine where they wish to seek employment
D)Helps meet accreditation requirements for the curriculum

Question 6

Which of the following best describes the U.S.health care system?

A)It is a mixture of social welfare and comprehensive care.
B)It is decentralized and expensive.
C)It is highly centralized and autocratic.
D)It assures basic minimal care to everyone.

Question 7

A community/public health nurse is caring for a client who has a health insurance plan which offers a looser organizational structure and has no requirement for primary care physician approval before seeing a specialist.Which type of health insurance does this client most likely have?

A)Health care network
B)Health maintenance organization
C)Point of service plan
D)Preferred provider organization

Question 8

The federal government obtains its authority to be involved in health care from the

A)Legislation that was passed giving the federal government that privilege.
B)Regulation of interstate commerce and its responsibility to provide for the general welfare.
C)Constitution,specifically allocating authority for health care to the federal government.
D)States requesting the federal government,because of its taxing ability,to accept that responsibility.

Question 9

A community/public health nurse is speaking with a group of elderly citizens about how the state health agency operates as part of the state government.Which of the following information would likely be included?

A)Every state health agency has a similar organizational structure and offers similar services to its citizens.
B)Each state health agency has many different departments,commissions,agencies,and boards.
C)Each state health agency depends primarily on federal funding and guidance in meeting health concerns.
D)Every state health agency delegates authority or funds to local boards of health.

Question 10

Which federal agency is most involved in both direct and indirect health-related responsibilities?

A)U.S.Department of Health and Human Services
B)National Health Care Service Agency
C)Public Health Service
D)Veterans Administration Medical Services Branch

Question 11

A public health nurse is examining the effectiveness of a health care system.Which of the following data would be the most appropriate for the nurse to use?

A)The number of resources expended by the system
B)The health of the population served
C)The number of noncitizens who seek health care in the system
D)The typical cost of routine primary care

Question 12

A client has recently changed health insurance plans and is now part of a health maintenance organization (HMO).How might the nurse best explain how HMOs operate?

A)HMOs provide creative ways to ensure hospitals can decrease their daily census.
B)HMOs employ a group of nurses who focus on health education programs.
C)HMOs encourage physicians to focus on health promotion and self-care.
D)HMOs organize a network of providers who offer services for a predetermined fee.

Question 13

What is the main difference in the health care system in the United States between President Clinton's vision in 1994 and today's reality?

A)Funding is totally centralized or decentralized.
B)Oversight is a public or private responsibility.
C)Health care team leadership is shared.
D)Pharmaceuticals are purchased through a payer system.

Question 14

A recently hired community/public health nurse is learning about the responsibilities of the local health department during orientation.Which of the following responsibilities would be discussed?

A)Meeting the demands of the local citizens
B)Implementing programs as directed by the state health commissioner
C)Addressing needs that have been delegated by state health agencies
D)Assuring that services are provided to meet the needs of vulnerable populations

Question 15

From where does the state obtain its authority to be involved in health care?

A)Delegation from the federal level to the states
B)Local governments requesting the state government accept that responsibility
C)The Constitution,which reserved for states all powers not specifically given to the federal government
D)The demand from citizens that a more regionalized authority be responsible

Question 16

A community/public health nurse is describing the American health care system to a group of immigrants.How would the nurse best describe this system?

A)As a static,complex entity that the nurse must seek to understand
B)As clearly the best in the world and envied by other countries
C)As extremely effective,especially in high-technology care
D)As being in the midst of ongoing change that offers real opportunities

Question 17

A community health nurse is caring for a client who is not a veteran and has no funds for health care.Where would this client go to receive care?

A)Local hospital
B)Privately owned,for-profit hospital
C)Proprietary hospital
D)Publicly owned hospital

Question 18

What are the two systems of health care that exist in the United States?

A)Federal system for military personnel and community system for others
B)Home-based care for wealthy and nursing home care for poor
C)Hospitals for acute care and outpatient clinics for chronic care
D)Private system for those who can pay and public system for some of the poor

Question 19

A client has a point-of-service health care plan.Why would the community/public health nurse need to consult this client's physician?

A)The physician is the budget officer,who makes decisions about the cost of care.
B)The physician is a collaborator,who is the leader of the health care team.
C)The physician is the expert medical diagnostician,who decides on interventions.
D)The physician is the primary care gatekeeper,who determines appropriate referrals.

Question 20

In comparison with other similar industrialized countries,the U.S.health care system results in

A)Outcomes very similar to outcomes in other industrialized countries.
B)Superb outcomes,perhaps because of the advanced research and technology.
C)The highest life expectancy and lowest infant mortality.
D)The lowest life expectancy and highest infant mortality.

Question 21

What was the primary reason public health lost power and influence in the 1960s?

A)Continued to emphasize prevention rather than hospital care
B)Forgot voters would rather pay for care from a private physician
C)Had significantly reduced many life-threatening health problems
D)Lobbyists were unable to influence legislators

Question 22

A community/public health nurse is preparing a presentation about the Patient Protection and Affordable Care Act-2010 for a community group.Which of the following information would the nurse include in the presentation? (Select all that apply.)

A)Insurance plans may place a limit on lifetime benefits.
B)Children under age 21 will be eligible to be covered under their parents' health insurance plans.
C)Medicaid eligibility will be expanded.
D)State governments will be responsible for insuring their residents.
E)Education loan repayment awards for health professionals practicing in underserved areas will be established.
F)Grant funding will be available for health care professionals gaining advanced education in shortage areas.

Question 23

What was one consequence of the Omnibus Budget Reconciliation Act of 1981?

A)There was a demand for local governments to give more free care.
B)There was a rise in the number of uninsured Americans.
C)An incredible increase in taxes occurred on different products and services.
D)Emergency department services expanded as people postponed seeing physicians.

Question 24

A community/public health nurse working in the 1990s wanted to improve the health of the community.According to economists,sociologists,and political activists,what was the best method to improve poor health?

A)Decrease poverty levels.
B)Increase funding to health care on the state level.
C)Increase the number of outpatient clinics for site-focused care.
D)Decrease the number of specialty physicians.

Question 25

A community/public health nurse educated a community group about the development of the national goals.Which of the following information would the nurse have included in this presentation?

A)Action plans are focused on changing lifestyles to reduce risks and prevent problems.
B)The goals emphasize improvement of health education in elementary and high schools.
C)The goals emphasize increasing the number of students in the health care professions.
D)Action plans are focused on aligning salaries for professionals among the health care disciplines.

Question 26

A nurse has referred a client to the managed care service provided by the hospital.What is the purpose of this referral?

A)To confirm that care options chosen are the least expensive possible
B)To coordinate the care provided by professional specialists
C)To keep the focus on the individual patient's unique needs
D)To review care to eliminate unnecessary services

Question 27

What was the most costly category of health care in the 1960s,which drastically increased after Medicare and Medicaid began?

A)Drugs and medical supplies
B)Hospital care
C)Physician services
D)Public health

Question 28

Which of the following is a reason the current nurse shortage is considered very serious? (Select all that apply.)

A)Current RNs are aging.
B)Enrollment in nursing programs is not increasing.
C)Additional nurses are pursuing graduate education.
D)An increasing number of nurses are specializing.
E)There has not been an increase in salaries.
F)Many nurses are entering the military causing a shortage in civilian hospitals.

Question 29

How do nurses differ from most other professional health care providers?

A)Nurses are committed to caring for others.
B)Nurses are heavily involved in ongoing research programs.
C)Nurses are primarily employees of an organization.
D)Nurses do not expect a fair salary because nurses are primarily women.

Question 30

A conflict exists between an insurance company and a physician.Which of the following is most likely the root cause of this conflict?

A)Contribution of the client
B)Distribution of power
C)Compensation of the provider
D)Regulation of finances

Question 31

Why were health system agencies (HSAs)discontinued? (Select all that apply.)

A)Consumers were not interested and would not become involved.
B)People were afraid of federal control.
C)The states refused to continue to fund such efforts.
D)Nurses did not receive appropriate salary raises under HSAs.
E)President Reagan was philosophically opposed to limits on the free market.
F)Vested interest groups (AHA,AMA)opposed HSAs.

Question 32

Before 1965 most consumers and health care providers were not concerned about health care costs because

A)Insurance companies were not worried about making a profit.
B)Many employees had such low co-pays and deductibles.
C)Expenses were paid by insurance reimbursement for employees who received insurance as a fringe benefit.
D)Physicians were receiving adequate reimbursements in a timely manner when they submitted claims correctly.

Question 33

A community/public health nurse discusses the current health care system with a class of finance students.A student asks why the U.S.government has not moved to a single-payer system.Which of the following statements would be an appropriate response by the nurse?

A)"Drug companies report that they would go bankrupt if such a plan were implemented."
B)"It has been demonstrated that administrative costs would greatly increase."
C)"It would be difficult to implement and more expensive than our current approach."
D)"The political influence held by those with a strong interest in maintaining the current system has prevented this change."

Question 34

A nurse is discussing with a colleague the current nursing issues occurring at the hospital where he is employed.Which of the following topics are most likely to be reported? (Select all that apply.)

A)Budget constraints have not allowed an increase in nursing salaries.
B)There is increased specialization by professional nurses,contributing to a nursing shortage.
C)Staffing by registered nurses has decreased while use of unlicensed assistive personnel has increased.
D)Nurses are demanding a share in decision making.
E)Sign-on bonuses and recruitment of new graduates are used to maintain nursing staf
F)Third-party reimbursement is difficult for advanced practice nurses to obtain.

Question 35

A nurse is providing care for a client in a hospital.In which of the following situations would the hospital no longer receive Medicare reimbursement?

A)Consulting with a physician if an advanced practice nurse is available
B)Providing inpatient care if procedures could be done on an outpatient basis
C)Prescribing trade name drugs when generic alternatives are available
D)Treating a urinary tract infection that occurred during hospitalization