ch 55 Flashcards
What do the economics of health care include?
a. Medicare and Medicaid dollars
b. Patients’ rights
c. Equal distribution of health care
d. Nurse salaries
ANS: C
The economics of health care include the equal distribution of healthcare services so everyone may be served when services are needed. Medicare and Medicaid, patients’ rights, and nurse salaries do not factor into the economics of health care; they are only parts of the healthcare system.
A student asks the instructor about healthcare economics. The instructor knows the student understands when the student makes which statement?
a. “The elderly population uses most of the healthcare services.”
b. “Everyone should have health insurance to obtain services.”
c. “Healthcare dollars should be partitioned by the government.”
d. “Resources will be needed to serve healthcare issues.”
ANS: D
Every healthcare issue needs resources to bring it to fruition. Without the resources, the healthcare issue would not be served. The elderly are a large part of the population, but that does not change the economics of health care. Everyone does not have health insurance so that statement would not enter into healthcare economics. Last, all health care dollars are not partitioned by the government; third party payers exist.
The U.S. healthcare system is different from that of other countries in which way?
a. The United States charges money from the private sector only.
b. U.S. health care is funded from private organizations.
c. The U.S. healthcare system is not entirely government funded.
d. The U.S. healthcare treats the older person first.
ANS: C
Other countries fund the healthcare system so that every citizen may have health care. In addition they provide the option that citizens may purchase private health care too. The United States has a combination of private companies and government agencies funding health care, so money is not coming from just the private sector. The older person in the population receives care according to the insurance coverage they have, but the care is not before anyone else.
Which of the following statements is true about health care in the United States?
a. The United States spends more money on health care than any other nation.
b. The United States provides health care to every citizen.
c. The United States relies on government funding to treat most citizens.
d. The United States spends less money on pediatric care than other nations.
ANS: A
The United States spends more money on health care than any other country. The United States does not provide health care to every citizen, nor does it rely entirely on government funding. The United States does not spend less money on pediatric care but usually more than other countries.
Two nurses are discussing managed healthcare organizations. The two nurses know which to be true about managed health care?
a. Care is mostly provided by nurses.
b. Prices for care are negotiated by the patient.
c. Providers may encounter additional cost if care provided exceeds reimbursement.
d. Patients can select any healthcare provider for treatment without additional costs.
ANS: C
Managed healthcare organizations include both PPO (Preferred Provider Organizations) and HMO (Health Maintenance Organizations). Fees are determined by the insurance company with a provided listing of healthcare providers who are in-network. Delivery of care is physician based. Additional costs to the patient may be incurred if the patient decides to see an out-of-network healthcare provider. Providers are paid a preset reimbursement for each patient and may suffer losses if their cost exceeds this stipulated amount.
A student nurse is discussing Medicare coverage with the clinical instructor. The instructor knows the student understands Medicare when the student makes which statement(s)? (Select all that apply.)
a. Medicare covers all patients while they are in the hospital.
b. Medicare is funded by the federal government.
c. Medicare is for persons 65 years old and older.
d. Medicare is partially funded by private third-party payers.
e. Medicare is for patients who are disabled and/or have end-stage renal disease.
ANS: B, C, E
Medicare is funded by the federal government. It covers people who are 65 years old and older, disabled people, and patients who have end-stage renal disease. It does not cover all patients in the hospital, because some patients do not qualify for Medicare. It is not funded by third-party payers.
An Accountable Care Organization (ACO) seeks to deliver which of the following aspects of health care? (Select all that apply.)
a. Lessen Medicare payments
b. Integrate care
c. Enhance evidence-based practices
d. Manage acute conditions
e. Support hospice charges
ANS: B, C
ACOs work to integrate care, manage chronic conditions, and enhance the use of evidence-based practices. They do not have any involvement with Medicare payments, the management of acute conditions, or hospice care.
