Exam 7: Paying for Health Care in America: Rising Costs and Challenges

A young mother has detected a lump in her breast, and because she lives at the poverty level, she is covered under Medicaid. This individual:

A nurse is very interested in learning more about health care economics and how she can use that knowledge to become a better patient advocate. She comments, "Nurses should not only deliver care one day at a time in one facility but should coordinate patient care as they move from acute care to rehabilitation to home care." This nurse would be a candidate for which nursing role?

In the triad of health care, which would be considered the third-party payer?

Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as:

Medicare would be responsible for: (select all that apply)

A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women's health specialist because the primary care physician did not order the referral or the mammogram. Which type of insurance plan adheres to this type of payment system?

Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing:

A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement?

A nurse who speaks at a health fair states that current attempts to increase efficiency of health care include: (select all that apply)

A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a _____ payment system.

A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services?

A patient is eligible to change health care providers and insurance and asks, "I am interested in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would support these activities rather than just pay for services when I am sick"? Which, if any, health insurance plan would best meet the needs of this patient?

An older adult client was admitted to the hospital with the condition classified as "pneumonia." Reimbursement was based on a predetermined fixed price. This classification system is referred to as:

The type of insurance that shifts the largest percentage of costs for goods and services to employees and consumers is _____________ insurance.

The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a _____ nurse.

A nurse is newly employed by a state-owned hospital that provides health care insurance requiring a deductible paid by the employee with the majority of the premium cost covered by the employer. The insurance provided to the nurse is:

A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer. The surgeon removed the left kidney. Medicare will no longer pay for preventable medical errors known as ____________.

When reviewing the literature on the effects of Medicaid on health care for the poor, the nurse researcher found that the poor:

The largest single payer of hospital charges in the United States is ___________.

A patient wants to reduce health care costs by being a model for making wise decisions that both promote health and reduce cost. Which statement by the patient would indicate a need for further teaching?