Chapter 05: Economics of Health Care Delivery (Stanhope: Public Health Nursing, 8th Ed)

Chapter 05: Economics of Health Care Delivery (Stanhope: Public Health Nursing, 8th Ed ) A characterization of the fourth developmental stage 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 facil ities c. Dependence on technology for patient care d. The discovery and development of pharmacological advances - ANS: C Nurses have become dependent on technologies to monitor client progress, make decisions about care, and deliver care in innovative ways . A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses, such as laboratory services and equipment. This part of Medicare is called Medicare Part: a. A b. B c. C d. D - ANS: B Medicare Part B is a supplemental (v oluntary) program; it provides coverage for services that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, equipment, and some supplies. A person with end -stage kidney failure who is on dialysis is eligible for : a. Medicaid b. Blue Cross c. Medicare d. HMO - ANS: C Medicare is available to anyone on dialysis regardless of age. A physician receives a set amount of money to provide care to a given group of clients for a set period of time. This is an example of: a. Retrospective reimbursement b. Prospective reimbursement c. Fee -for-service d. Capitation - ANS: D Capitation describes the practice of paying 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. This is similar to prospective reimbursement for health care organizations. A public health nurse is counseling a client who is trying to determine if a health maintenance organization (HMO) or preferred provider or ganization (PPO) will provide the better health care coverage. One main difference between these two types of managed care arrangements is: a. HMOs provide comprehensive care to its members for a fixed fee. b. PPOs designate providers that members can cho ose. c. PPOs employ physicians as PPO employees. d. HMOs provide financial incentives to encourage members to select HMO providers. - ANS: A The HMO is a provider arrangement whereby comprehensive care is provided to members for a fixed per member per mont h fee. A PPO uses predetermined rates for services to be delivered to members. HMOs have multiple models of delivery including the staff model, where physicians are HMO employees. PPOs provide financial incentives to encourage members to select PPO provide rs. An employee is able to receive health insurance from a former employer after changing jobs because of the: a. Health Insurance Portability and Accountability Act (HIPAA) b. Omnibus Budget Reconciliation Act c. Balanced Budget Act of 1997 d. Social Se curity Act - ANS: A HIPAA is a federal intervention to protect health insurance coverage for workers and families following a job change or loss. An example of a macroeconomics issue faced by nurses is: a. The evaluation of client access to services b. A health policy that makes the development of a new program possible c. Informing clients and others of the cost of service d. The referral of clients to available services - ANS: B Macroeconomics focuses on the big picture, such as a program, whereas microeconomics focuses on the individual or organization. An example of managed care is: a. Medicare b. Medicaid c. Medical savings accounts d. Health maintenance organizations - ANS: D Health maintenance organizations and preferred provider organizations are types of managed care.