Health Care Reform- Exam 2
When describing managed competition as a potential solution to resolve the health care crisis, which of the following would be included? Managed competition would A) promote cost containment and universal access to health care. B) eliminate burdensome government regulations. C) reduce state and federal control over health care delivery. D) discourage consumers from making responsible choices.
A Feedback: Managed competition ideally would promote cost containment and universal access to health care. Governmental regulations and control would still be present as would insurance companies. Managed care would encourage consumers to make responsible choices.
After teaching a community group about the Medicaid program, which of the following would indicate to the nurse that additional teaching is necessary? A) Medicaid has a monthly fee that recipients must pay. B) Medicaid is administered individually by each state. C) Medicaid focuses on preventative services. D) It is possible to be on both Medicare and Medicaid.
A Feedback: Medicaid monies come to the states from the federal government. Each state determines who will receive what kinds of health care services. This makes it a uniquely different program in each state. Medicaid is a free program available to individuals on the basis of financial need and legal residency status. Medicaid has a major focus on preventative services, namely, infant, childhood, and elder immunization programs. Eligibility is determined on the basis of financial need and residency status. Finally, some low-income Medicare eligible people also receive Medicaid.
Which of the following statements about the core public health functions are true? A) Public health nurses practice as partners with other public health professionals within these core functions. B) Assessment involves the actual provision of services. C) Policy development relates to assessment. D) Assurance means that the public health agency must directly provide the needed services.
A Feedback: Public health nurses practice as partners with other public health professionals within these core functions. Assessment does not involve the actual provision of services (assurance does). Public policy development builds on data from the assessment function. Assurance is the process of translating established policies into services. This function ensures that population-based services are provided, whether by public health agencies or private sources.
Which one of the following groups of actions fulfills the three core public health functions in their proper order? A) Counting the number of kindergarten students who are fully immunized, encouraging the school officials to exclude children who are not fully immunized, and offering immunization clinics at the school B) Identifying a source of pollution in the community, educating local residents about precautions that should be taken when the pollution exceeds minimum standards, and asking legislators to apply sanctions to the responsible party for the source of pollution C) Providing prenatal care for pregnant adolescents, determining how many pregnant adolescents currently attend the school, and encouraging school officials to provide an alternative school setting for the pregnant adolescents D) Lobbying for a citywide ban on smoking in public, providing smoking cessation services in the community, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer
A Feedback: The three core public health functions are assessment, policy development, and assurance. Assessment is data collection, the policy development would be based on the assessment, and assuring is the process of translating established policies into services. Counting the number of kindergarten students who are fully immunized would be assessment, encouraging the school officials to exclude children who are not fully immunized would be policy development, and offering immunization clinics at the school would be assurance. Identifying a source of pollution in the community would be assessment, educating local residents about precautions that should be taken when the pollution exceeds minimum standards would be assurance, and asking legislators to apply sanctions to the responsible party for the source of pollution would be policy development. Providing prenatal care for pregnant adolescents would be assurance, determining how many pregnant adolescents currently attend the school would be assessment, and encouraging school officials to provide an alternative school setting for pregnant adolescents would be assurance. Lobbying for a citywide ban on smoking in public would be policy development, providing smoking cessation services in the community would be assurance, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer would be assessment.
Over the past century, many health-related changes have occurred affecting morbidity and mortality. As community health nurses assess and plan for services in the community, an understanding of which of the following changes would the nurses need to integrate into their plans? Select all that apply. A) High levels of chronic disease B) Shortened life spans C) Increased teen pregnancies D) Abuse of multiple substances E) Increased maternal mortality F) Multidrug-resistant diseases
A, C, D, F Feedback: Issues today include high levels of chronic disease, increase in teen pregnancies, abuse of multiple substances, and multidrug-resistant disease. Shortened life spans and increased maternal mortality were real issues in the 1900s but are significantly different today. With the shortened life span over 100 years ago, people were not living long enough to develop a long history of chronic disease. Maternal mortality was high 100 years ago as prenatal care and the technology of today did not exist.
A group of students are preparing for an examination on the various events serving as landmarks for health care legislation. The students demonstrate understanding of these events by identifying which of the following statements about particular landmark health legislation are true? Select all that apply. A) The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. B) The Shepard-Towner Act provided funds to states for hospital construction. C) The Hill-Burton Act provided funds to states for administration of programs to support the health and welfare of mothers and infants. D) The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. E) The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. F) The Patient Protection and Affordable Care Act attempted to ensure the privacy of medical records.
A, D, E Feedback: The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. The Hill-Burton Act provided funds to states for hospital construction. The Shepard-Towner Act provided federal funds to states for administration of programs to support the health and welfare of mothers and infants. The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. The Health Insurance Portability and Accountability Act attempted to ensure the privacy of medical records.
A community health nurse primarily works with mothers and their high-risk children, often referring them to various voluntary agencies for services. Which of the following would be examples of voluntary health agencies? Select all that apply. A) American Diabetes Association B) The U.S. Public Health Service C) The National Institutes of Health D) Women, Infant, and Children Program (WIC) E) National Society for Autistic Children F) Planned Parenthood Federation of America
A, E, F Feedback: The American Diabetes Association, National Society for Autistic Children, and Planned Parenthood Federation are examples of voluntary agencies supported by nonfederal funds and are nonprofit organizations. The U.S. Public Health Service, the National Institutes of Health, and the WIC program are federal agencies or receive federal funds to operate; thus they are not voluntary agencies.
Which of the following statements about Health Care Rationing is most accurate? A) It will not occur in the United States because of our country's values. B) A danger of rationing is compromising quality and effectiveness. C) Rationing in health care has never been practiced. D) Advances in knowledge and technological capabilities will eliminate the need for rationing in the future.
B Feedback: A danger of rationing is compromising quality and effectiveness. Rationing is already practiced in this country to some extent and for many years. Advances in knowledge and technological capabilities compound rationing decisions.
When seeking employment, a community health nurse decides to focus the search on official health care agencies, based on the understanding that these agencies are A) voluntary. B) tax supported. C) proprietary. D) privately funded.
B Feedback: Official health care agencies, later called public health agencies, are tax supported; thus, they must provide services determined by the federal, state, or local government. Voluntary or private agencies are privately funded. Proprietary health services are privately owned and managed and may be for profit or nonprofit.
Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies? A) Public sector health care agencies are more likely to pilot or subsidize demonstration projects. B) Private sector health care agencies are more likely to promote health legislation. C) Public sector health care agencies are more likely to generate new research and innovation. D) Private sector health care agencies usually focus on needs that are met.
B Feedback: Private sector health agencies are more likely to promote health legislation, whereas public sector health care agencies are more likely to be responsible for carrying out health legislation. Private sector health care agencies (not public) are more likely to pilot or subsidize demonstration projects and generate new research and innovation. Private sector health care agencies strive to detect unmet needs rather than met needs.
Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies? A) Private sector health services are complementary and supplementary to government health agencies. B) Public sector health care agencies usually meet the needs of people with special needs. C) Private sector health agencies usually are constrained in developing innovations in health care. D) Public health sector agencies generally satisfy the health care needs of a community.
B Feedback: Private sector health services are complementary and supplementary to government health agencies, but this is not a difference between the two types of agencies. Private sector health care agencies usually meet the needs of people with special needs (rather than public sector health care agencies that focus on the entire population within their jurisdiction). Private sector health care agencies are less constrained than public sector health care agencies in developing innovations in health care. A part of the reason for the development of private sector health care agencies is the impatience or dissatisfaction with government (public health) programs.
Which of the following would the community health nurse identify as a drawback to retrospective reimbursement? A) Spending was limited to the most necessary tests and treatments. B) Services for sickness were encouraged rather than wellness. C) Consumers had to bear the increased accountability for cost containment. D) Payments for services were based on rates calculated from predictions.
B Feedback: Retrospective payment is associated with encouraging sickness care rather than wellness services. Physicians and other providers were rewarded financially for treating illness and providing for additional tests and services. Patients and providers often insisted on expensive or unnecessary tests and treatment. Neither consumers nor providers were accountable for containing costs. Retrospective payment involves reimbursement for a service after it has been rendered with payment of a fee occurring after the fact.
Which of the following statements about the international health organization is most accurate? A) PAHO is completely separate from the WHO. B) UNICEF promotes child and maternal health and welfare globally. C) WHO focuses primarily on developing countries. D) WHO and UNICEF are agencies of the United Nations.
B Feedback: United Nations International Children's Emergency Fund (UNICEF) promotes child and maternal health and welfare globally. The Pan American Health Organization (PAHO) is the oldest continually functioning international health organization in the world and predates the World Health Organization (WHO). Initially, the PAHO was independent from the WHO but is now the WHO regional office for the Americas and receives part of its funding from WHO. WHO focuses on the promotion of health worldwide, not just developing countries. The United States Agency for International Development (USAID) focuses on developing countries. WHO and UNICEF are both agencies of the United Nations.
Which of the following most well describes a public health care agency? A) The agency most often has a very specific focus. B) The agency is responsible for promoting and protecting the health of all within their jurisdiction. C) The agency only employs nurses and environmental health practitioners. D) The agency is able to perform its work independently with complete autonomy.
B Feedback: Unlike private organizations that tend to have a specific focus, government health agencies exist to accomplish a broad goal of protecting and promoting the health of the total population under their jurisdiction. Public health requires interdisciplinary and interorganizational collaboration.
As part of a community wide education program, a community health nurse is developing a teaching plan about Medicare. Which of the following would the nurse include in the plan? Select all that apply. A) It is a state health insurance program for elderly and the disabled. B) Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services. C) Medicare Part D covers prescription drug costs. D) Medicare Part A is supplementary and voluntary. E) Medicare beneficiaries can make changes to their coverage at any time.
B, C Feedback: Medicare is a federal health insurance program and covers citizens and some legal aliens who are over 65 years old (not a State program). It also covers people with permanent disabilities or chronic renal disease at any age. Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing service. Prescriptions are covered under Medicare Part D. Medicare Part B is supplementary and voluntary. Medicare beneficiaries can make changes to their coverage during open enrollment periods.
Which of the following statements about trends and issues influencing health care economics and community health services delivery are true? Select all that apply. A) The United States has the most cost effective health care system in the world. B) One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. C) In the United States, the health-related quality of life is lower than for most other countries. D) The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. E) In a survey published in 2009, most US physicians identified that their health care system worked well.
B, C, D Feedback: The United States has one of the least cost effective health care systems in the world. One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. In the United States, the health-related quality of life is lower than for most other countries. The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. In a survey published in 2009, most US physicians did not identify that their health care system worked well.
When discussing the economics of health care with colleagues, the community health nurse addresses macroeconomic theory. Which of the following would the nurse include? A) Quantity of services available B) Consumer's willingness to buy services C) Aggregate perspective of economic stability D) Allocation of the available resources
C Feedback: Macroeconomic theory is concerned with the broad variables that affect the status of the economy as a whole, such as factors affecting aggregate consumptions, production, investment, and international trade. The focus is on the larger view of economic stability and growth, providing a global or aggregate perspective. Microeconomic theory addresses supply (quantity of services available) and demand (consumer's willingness to buy services) and study how allocation and distribution affect consumer demand for goods and services.
An instructor is preparing a class presentation on landmark health legislation. Which of the following would the instructor include as the most significant legislation that attempts to ensure access to health care for Americans? A) Social Security Act B) Hill-Burton Act C) Patient Protection and Affordable Care Act D) Omnibus Budget Reconciliation Act
C Feedback: Patient Protection and Affordable Care Act is expected to provide access to health care for 30 million Americans when fully enacted. The Social Security Act had tremendous consequences for public health with revolutionary welfare insurance and assistance programs, the provision of financial assistance to form state and local health agencies. The Hill-Burton Act (1946), Occupational Health and Safety Act (1970), and the Omnibus Budget Reconciliation Act (1981) are important acts that brought about changes in health care planning, safety, and funding.
Which statement regarding the potential impact of health care reform on community health nursing is most accurate? A) Health care reform does not affect community health nursing. B) Community health nurses know that outcomes research is unnecessary. C) Public health nurses can lead the effort in making health care more accessible to all citizens. D) Community health nurses will only be able to work in public health agencies.
C Feedback: Public health nurses can lead the effort in making health care more accessible to all citizens. Health care reform definitely affects community health nursing. Community health nurses recognize the importance of outcomes research to document the value of nursing interventions with at-risk populations. Community health nursing has important ties to both private and public health agencies.
After describing the Public Health Service to a group of students, which description would indicate the need for additional discussion? A) It offers consultation through national advisory health councils and special advisory committees made up of lay experts. B) The Secretary of Health and Human Services is ultimately responsible for it. C) The Secretary of Health and Human Services is an elected position. D) A major function is to administer grants and contracts with other government agencies.
C Feedback: The Secretary of Health and Human Services is a cabinet position. Cabinet positions are appointed by the President. The Public Health Service does offer consultation through national advisory health councils and special advisory committees made up of lay experts. The Secretary of Health and Human Services is ultimately responsible for the Public Health Service. A major function of the Public Health Service is to administer grants and contracts with other government agencies.
After a class on important historical influences on community health care, the students are asked to describe the impact of the Shattuck Report. Which response indicates that the students have understood the information? A) "It influenced the speed with which health-focused bills pass the legislature." B) "The report set up the organizational structure of the U.S. Public Health Service." C) "It emphasized sanitary progress forming the basis for current public health practice." D) "It de-emphasized the issues addressed in the Hebrew hygienic code."
C Feedback: The Shattuck Report, a landmark document, made a tremendous impact on sanitary progress addressing public health concepts and methods that form the basis of public health practice today. It had no effect on getting bills passed by the legislation nor was it involved in setting up the organizational structure of the U.S. Public Health Service. The Hebrew hygienic code, probably the first written code, was the prototype for personal and community sanitation.
A community health nurse working at the local level is attending an in-service program about health care economics. The nurse asks the presenter, "Why do I need to know this information? My focus is my clients." Which response by the presenter would be most appropriate? A) "You are required to know this information because your agency receives government funding." B) "You might be in management one day and have to deal with cost control and reimbursement." C) "Although it seems foreign to you, it's an important topic that you might have to deal with someday." D) "This knowledge is important to the success of your practice and for the agency's survival."
D Feedback: At the local level (the community health nurse and the employing agency), health care economics is very important for survival. Resourceful use of time, talent, and materials will ensure that the services will be able to continue and that the agency stays viable. Government funding, a future role in management, and dealing with the issue in the future are inappropriate and do not emphasize the importance of the effect of health care economics.
A community health nurse is engaged in provision of care to clients in a clinic setting at the local health department. This nurse is engaging in which core public health function? A) Clinical B) Assessment C) Policy development D) Assurance
D Feedback: The three core public health functions are assessment, policy development, and assurance. Assessment would involve assessing the community, policy development would involve helping to establish policies that will address the problems assessed, and assurance would involve making sure that the services indicated by policies (following assessment) are available to the community. Clinical is not a core public health function.
During a presentation at a local health department, a community health nurse discusses how society has changed over the past 100 years and the influence that these changes have had on the community's health care needs. Which of the following would the nurse include as a current societal event? A) Large disparity in male/female wages B) Rural to urban migration C) Rampant child labor D) Widespread violence
D Feedback: Today, society is faced with widespread violence and terrorism. Populated urban areas continue to loose people to the suburbs, while 100 years ago, people were leaving rural areas for urban areas. A century ago child labor laws were just forming and child labor was rampant.
