Deck 4: Financing of Health Care: Context for Communitypublic Health Nursing

Question 1

With regard to the effectiveness of the Medicare program,it can accurately be said that the program

A)Ensured that elderly persons received appropriate care.
B)Helped reduce health care costs.
C)Prevented elderly persons from suffering any major financial hardships.
D)Improved access to health care services for eligible persons.

Answer 1

Improved access to health care services for eligible persons.

Question 2

A company's chief executive officer (CEO)discusses potential ways to control employee health care costs with the organization's occupational health nurse.Which of the following recommendations would the nurse be most likely to suggest?

A)Suggest employees exercise and stop smoking to retain their employment.
B)Encourage the use of generic prescriptions and outpatient services.
C)Consider layoffs to decrease the number of employees who receive insurance.
D)Reward employees who have limited health care expenses.

Answer 2

Encourage the use of generic prescriptions and outpatient services.

Question 3

A community/public health nurse is visiting a nuclear family.Both of the parents are employed full-time,have a moderate income,and have health insurance.Which of the following is the most likely source of their health insurance?

A)Employer-paid insurance
B)Federal government-subsidized health insurance
C)Medicare/Medicaid program
D)Private-paid insurance

Answer 3

Employer-paid insurance

Question 4

A nurse educator teaches community/public health nursing students about how health care is financed in the United States.Why is it important that nursing students receive this information?

A)Nurses are expected to help patients find funding sources to pay for their care.
B)Nurses have to restrict their care to services that are financially reimbursed.
C)Health care organizations must charge patients for all supplies consumed while care is given.
D)Health care organizations must notify patients of the exact cost of the nursing services rendered.

Question 5

A community/public health nurse is working with a low-income family that has children and is uninsured.What recommendation made by the nurse would assist the children in obtaining health care?

A)Visit a free clinic at the health department.
B)Apply for Medicare.
C)Apply for the Children's Health Insurance Program (CHIP).
D)Visit the local pediatrician's office.

Question 6

How are the funds obtained to pay for the Medicare program?

A)A "Medicare" tax paid by all employees who pay Social Security tax
B)A tax on wages paid by employer and employee
C)Money from the federal income tax paid by all citizens
D)Social security funds paid by employer and employee

Question 7

Which of the following is true about access to care?

A)Care providers have always donated necessary services to make sure everyone received care.
B)Health care is rationed by the ability to pay.
C)Poverty-stricken patients received care from medical and nursing school students in teaching hospitals.
D)Universal access has always been a component of health care in America.

Question 8

Which component of government is primarily responsible for health research spending?

A)The federal government,through the Centers for Disease Control and Prevention
B)The federal government,through the National Institutes of Health
C)State governments,through grants to state universities and research centers
D)State governments,through local public health departments in cooperation with local researchers

Question 9

Which of the following was true concerning the amounts paid by private funds and governmental funds in 2009?

A)Government spent 49%,and private funding accounted for 51%.
B)Government spent 75%,whereas private funding accounted for 25%.
C)Government spent 40%,whereas private funding accounted for 60%.
D)It is unknown what proportion of funds was governmental and what proportion was private.

Question 10

The primary criticism that may truthfully be made of the Medicare program is that it

A)Does not meet the most serious medical needs of the population it serves.
B)Has inadequate controls on the amounts paid to health care providers.
C)Has not sufficiently reduced taxpayer cost.
D)Lacks adequate funding,and Medicare taxes continue to increase.

Question 11

An elderly client reports that he has been told that he needs to "spend down" in order to be eligible for Medicaid.He is confused about what he needs to do in order to accomplish this task.Which of the following statements is the best response from the community/public health nurse?

A)"You will have to spend your own money to pay for the Medicaid premiums."
B)"You will have to spend your own funds until you are eligible for Medicare."
C)"You will have to exhaust most of your assets before receiving benefits."
D)"You will have to meet a certain deductible amount before receiving benefits."

Question 12

A community/public health nurse is working with vulnerable populations in the community.Which population would be most likely to not have health insurance?

A)Elderly persons who do not qualify for Social Security
B)Homeless persons who lack a permanent address
C)Working poor persons whose jobs lack health insurance as a benefit
D)Young families who have not yet saved enough to qualify

Question 13

Self-payment of health care costs are

A)Almost never done because that is the purpose of health insurance.
B)Frequently done because many employers do not offer a health insurance benefit.
C)Frequently done by paying for one's own insurance to ensure coverage.
D)Usually done by paying co-payments and deductibles required by insurance.

Question 14

A nurse has chosen to provide home care services to a needy client even though there is no source of reimbursement for this care.What problem may result?

A)The nurse will be expected to provide this care to other clients.
B)The nurse may not be covered in case of a malpractice claim.
C)The agency's clients will start demanding that the staff provide free care.
D)The agency's clients will be at risk for being billed for the services provided.

Question 15

A community/public health nurse is discussing insurance options with a healthy,young adult client who has recently lost her job.Why would the client most likely not be receptive to obtaining privately paid health insurance?

A)Health care services can be obtained at a local free clinic.
B)She prefers to spend her money on higher priority needs than insurance.
C)The monthly premiums are just too high to be affordable.
D)She has no need for insurance because she is young and healthy.

Question 16

A community/public health nurse is examining how health care dollars are distributed in the United States.Which of the following information would the nurse find in the literature?

A)The majority of health care dollars are spent on health promotion activities.
B)The percentage of health care dollars spent on public health activities is increasing.
C)The percentage of health care dollars spent on health care advances is increasing.
D)The majority of health care dollars are spent on personal health care services.

Question 17

Why was the Health Insurance Portability and Accountability Act (HIPAA)not successful at making insurance more available?

A)It provided for medical savings accounts,which were not what people wanted.
B)It focused primarily on protecting the confidentiality of patient records,not insurance.
C)It was repealed shortly after its passage.
D)It did not limit what companies could charge for the insurance.

Question 18

Research has demonstrated that which of the following relationships is true with regard to paying for care?

A)The higher the co-payment,the less health care the person seeks.
B)The higher the co-payment,the more the patient thinks the care was "worth the cost."
C)The lower the co-payment,the more compliant patients become with the suggested treatment.
D)The lower the co-payment,the more patients feel they can always get the care later.

Question 19

What approach have nurses historically used when providing care and paying attention to costs?

A)Giving the best possible nursing care regardless of ability to pay
B)Giving whatever care the nurse has the expertise to give
C)Giving whatever care the patient could afford
D)Giving whatever care the patient desired and for which he or she was willing to pay

Question 20

A community/public health nurse is providing home care services to an elderly couple.They report that they believe they are spending more and more money on health care services and have limited funds available to meet their everyday living expenses.Which of the following offers the best explanation for their situation?

A)The proportion of the gross domestic product devoted to health care is increasing.
B)The health care costs are increasing for the elderly population.
C)The cost of living is increasing because of recent rapid inflation.
D)The cost of health care is increasing because more people are insured.

Question 21

A community/public health nurses states that the United States has an integrated health care system.What is meant by this statement?

A)The larger for-profit managed care organizations are absorbing smaller organizations so that eventually only three to five large companies will exist.
B)Large organizations are trying to own or control a complete range of health care facilities to meet all health care needs of their enrollees.
C)Large managed care organizations are employing attorneys as employees to ensure that no malpractice suit against them can be successful.
D)Physicians are choosing to become employees to avoid paying for malpractice insurance and therefore are being absorbed into hospital systems.

Question 22

Which of the following actions demonstrates the community/public health nurse advocating for the community?

A)Encouraging the media to run personal interest stories on needy clients
B)Becoming an active member of a professional nursing organization
C)Offering to organize a fundraising campaign for needy families
D)Suggesting appropriate agencies where families can receive services

Question 23

The major method used to reduce costs to third-party payers has been to

A)Change the eligibility requirements.
B)Convert reimbursement to a retrospective payment plan.
C)Require all clients to choose a managed care plan for reimbursement.
D)Set fee schedules to restrict increases in provider payment.

Question 24

Which of the following populations accounts for the majority of the cost in the Medicaid program?

A)Children younger than 5
B)Elderly persons
C)Low-income families
D)Single pregnant women

Question 25

What is the main problem with Medicare Part D?

A)The plan allows elderly persons to purchase medications from certain mail-order companies.
B)The plan covers generic,not brand-name,drugs.
C)Medicare recipients are confused by what the plan will or will not cover.
D)There is a coverage gap in which recipients have to pay full cost of drugs.

Question 26

For which of the following clients will care not be reimbursed by Medicare?

A)A terminally ill client who is receiving hospice care
B)A client who is hospitalized for pneumonia
C)A client who requires intermittent skilled home health care
D)A client who needs long-term care in a nursing home

Question 27

What is notable about Medicare Advantage?

A)Because it is a new program,no one has yet seen any problems with this aspect of Medicare.
B)Insurance salespeople have been very careful in explaining this program to elderly persons.
C)More insurance companies are marketing such plans to elderly persons.
D)Unless the elderly person is very healthy,the plan may cost more than the original Medicare.

Question 28

On what basis can Medicare be criticized? (Select all that apply.)

A)Even after age 65,many elderly citizens are not eligible for Medicare.
B)Medicare pays less than half of recipients' health care costs,which is a major hardship for many recipients.
C)Medicare does not protect elderly people from financial destitution when they pay for needed care.
D)Most physicians and hospitals do not accept Medicare recipients.
E)Until 2007,the premiums were the same whether the recipient was very wealthy or very poor.
F)Until 2011,Medicare paid for procedures in hospitals but not in outpatient settings.

Question 29

As part of the orientation program at a local public health department,the newly hired nurse learns about the resources that are available in the community.What is the reason for including this information?

A)So that the nurse is able to advise clients on how to obtain food stamps
B)So that the nurse is able to determine who is eligible for certain services
C)So that the nurse will be able to include other departments in providing care
D)So that the nurse will be able to refer clients to the appropriate resources

Question 30

Of the following,persons,who is most likely to receive Medicaid benefits if the family income is below the poverty level?

A)A 16-year-old child
B)A pregnant woman with a 3-year-old child
C)A single-parent family
D)A two-parent family in which the father is unemployed

Question 31

Of the following persons,who is most likely not to receive benefits under Medicaid,regardless of financial status?

A)A 3-year-old child
B)A 21-year-old pregnant woman
C)A single-parent family
D)A two-parent family

Question 32

Which of the following statements most accurately summarizes the current view of health care in the United States?

A)The government should allow Americans to receive the health care they can afford.
B)The government should trust the free market system.
C)The government should assume responsibility for providing basic care to all.
D)The government should provide basic care to those who cannot care for themselves.

Question 33

What are the primary reasons for the ongoing increase in health care costs in the United States? (Select all that apply.)

A)Changes in population demographics
B)Improved end-of-life care
C)Ongoing research studies
D)Periodic financial inflation
E)Rising expectations by consumers
F)Technologic advances