5 - Economics of Health Care Delivery Flashcards
A nurse plans to implement a primary prevention strategy in the community. Which of the following would the nurse most likely complete?
a. ) Development of a smoking prevention program
b. ) Development of a support group for widows
c. ) Development of a hypertension screening program
d. ) Development of a hospice care program
a.) Development of a smoking prevention program
Primary prevention’s aim is preventing disease. Development of a smoking prevention program is primary prevention. Development of a support group for widows and development of a hospice care program are examples of tertiary prevention. Development of a hypertension screening program is an example of secondary prevention.
A nurse is working with members of the community to assist them with acquiring health insurance. Which of the following individuals is most likely to be uninsured?
a. ) An 82-year-old woman with chronic medical problems
b. ) A 2-year-old whose mother is on welfare
c. ) A 50-year-old businessman who works for a large corporation
d. ) A 32-year-old man who works part-time at a small business
d.) A 32-year-old man who works part-time at a small business
The typical uninsured person is one who works at a low-paying job, part-time or temporary, or at a small business. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, since most large businesses provide it.
When a health care organization’s fees for delivery of services are not decided until after they are provided, it is called:
a. ) retrospective reimbursement.
b. ) prospective reimbursement.
c. ) fee-for-service.
d. ) capitation.
a.) retrospective reimbursement.
Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered.
Prospective reimbursement is whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering services to the client.
Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill.
Capitation is similar to prospective reimbursement for health care organizations; third-party payers determine the amount that practitioners will be paid for a unit of care.
The allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care is called:
a. ) economics.
b. ) health economics.
c. ) public health economics.
d. ) microeconomic theory.
b.) health economics.
Health economics is the allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care. Economics is the science concerned with the use of resources, including the production, distribution, and consumption of goods and services. Public health economics focuses on the production, distribution, and consumption of goods and services as related to public health and where limited public resources might best be spent to save lives or increase the quality of life. Microeconomic theory deals with the behaviors of individuals and organizations and the effects of those behaviors on prices, costs, and the allocation and distribution of resources.
A nurse discusses services with a federal congressman. Which of the following services would the nurse most likely be discussing?
a. ) Family planning
b. ) Counseling
c. ) Policy making
d. ) Prevention of communicable diseases
c.) Policy making
Policy making is offered at the federal level. Family planning, counseling, and preventing communicable and infectious disease are offered at the state and local levels.
An employee is able to receive health insurance from a former employer after changing jobs. Which of the following best describes the legislation that makes this possible?
a. ) Health Insurance Portability and Accountability Act (HIPAA)
b. ) Omnibus Budget Reconciliation Act
c. ) Balanced Budget Act of 1997
d. ) Social Security Act of 1935
a.) Health Insurance Portability and Accountability Act (HIPAA)
HIPAA is a federal intervention to protect health insurance coverage for workers and families following a job change or loss. The Omnibus Budget Reconciliation Act was a major effort to regulate and control the costs of physician fees. The Balanced Budget Act of 1997 determined that payments to Medicare skilled nursing facilities (SNFs) would be made on the basis of prospective payment system (PPS). The Social Security Act of 1935 signaled the federal government’s increasing interest in addressing social welfare problems.
When a third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the service to the client, it is called:
a. ) retrospective reimbursement.
b. ) prospective reimbursement.
c. ) fee-for-service.
d. ) capitation.
b.) prospective reimbursement.
Prospective reimbursement is 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. Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill. Capitation is similar to prospective reimbursement for health care organizations; third-party payers determine the amount that practitioners will be paid for a unit of care.
A nurse implements a teen pregnancy prevention program in a high school that has been shown to decrease the rate of teen pregnancy. Which of the following best describes the nurse’s action?’
a. ) Effectiveness
b. ) Efficiency
c. ) Microeconomics
d. ) Production
a.) Effectiveness
Effectiveness refers to the extent to which a health care service meets a stated goal or objective, or how well a program or service achieves what is intended. Efficiency refers to producing maximum output using a given set of resources. Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and budget constraints of health care. Production refers to how goods are produced or created.
A nurse is examining the characteristics that affect one’s health. Which of the following would be of greatest concern to the nurse?
a. ) Obesity
b. ) Marital status
c. ) Health insurance
d. ) Age
a.) Obesity
Personal behavior/lifestyle (obesity) has the greatest effect on health. Environmental factors (marital status) and human biology (age) are next followed by the health care system (health insurance).
A characterization of the fourth developmental phase of the health services delivery framework is:
a. ) nurses in the United States being predominantly women.
b. ) the expansion of the number and type of health care facilities.
c. ) dependence on technology for patient care.
d. ) the discovery and development of pharmacological advances.
c.) dependence on technology for patient care.
Nurses have become dependent on technologies to monitor client progress, make decisions about care, and deliver care in innovative ways as part of the fourth phase. The discovery and development of pharmacological advances is only one way that technology has increased during the fourth phase. Phase one was concerned with epidemics and infectious disease control. Physicians and nurses attained skills in scientifically based programs in phase two. Phase three included the expansion of hospital clinics and long-term care facilities.
A nurse is discussing the services that are covered under Medicare Part A with a client who has recently become eligible for Medicare. Which of the following services is the nurse most likely to mention?
a. ) Blood draw to assess prothrombin time (PT)/International Normalized Ratio (INR)
b. ) Physical therapy visit
c. ) Stay in skilled nursing facility
d. ) Transportation by an ambulance
c.) Stay in skilled nursing facility
Medicare Part A covers hospital care, home care, and skilled nursing care.
Laboratory and physical therapy services and transportation by ambulance would be covered by Medicare Part B.
A nurse is working with a client who receives health insurance through a managed care organization. Which of the following best describes this insurance?
a. ) Medicare
b. ) Medicaid
c. ) MSAs
d. ) Health maintenance organizations
d.) Health maintenance organizations
Health maintenance organizations and preferred provider organizations are types of managed care. Medicare and Medicaid are government insurance programs. MSAs are not a type of health insurance.
Which was considered the first national health insurance plan in the United States?
a. ) Health Maintenance Organization (HMO) Act
c. ) Marine Hospital Service
c. ) Medicare
d. ) Medicaid
c.) Marine Hospital Service
The Marine Hospital Service was created in 1798 by the federal government to provide medical service for sick and disabled sailors and to protect the nation’s borders against the importing of disease through seaports. The HMO Act provided assistance and expansion for HMOs in the 1970s. Medicare and Medicaid were established in 1965 to provide health care services to certain populations.
A community health nurse is assisting clients to access health care. Which of the following individuals would most likely experience a barrier when accessing health care?
a. ) A 40-year-old female who speaks English
b. ) A 25-year-old female with health insurance
c. ) A 50-year-old male with hypertension
d. ) A 30-year-old male who is unemployed
d.) A 30-year-old male who is unemployed
Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, child care needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income.
A nurse enrolls in a microeconomics course at a local college. Which of the following best describes the rationale for taking this course?
a. ) Nurses are often the ones to allocate resources to solve a problem.
b. ) Nurses are often involved in federal policy making.
c. ) Health care policy can be influenced using these principles.
d. ) Health care supplies can be very costly and nurses must use them wisely.
a.) Nurses are often the ones to allocate resources to solve a problem.
Nurses often allocate resources, design, plan, coordinate, and evaluate community-based health services. Policy making addresses a macroeconomics issue. It is true that nurses need to know about microeconomics in order to use resources appropriately, but the scope of quality of care and use of health care supplies is larger than the scope of only microeconomics.
