Nursing Quiz: The United States Healthcare System Overview

Before 1965, most consumers and health care providers were not concerned about health care costs because expenses were paid by insurance reimbursement for employees who received insurance as a fringe benefit. This means that individuals did not have to directly bear the financial burden of their healthcare expenses as it was covered by insurance. This lack of financial responsibility resulted in a lack of concern about healthcare costs among consumers and healthcare providers.

The correct answer is c. The Constitution, which reserved for states all powers not specifically given to the federal government. This answer is correct because according to the Constitution, the powers not delegated to the federal government are reserved for the states. This means that the state obtains its authority to be involved in healthcare from the Constitution, as healthcare is not specifically mentioned as a federal power.

The main difference in the health care system in the United States between President Clinton's vision in 1994 and today's reality is the responsibility for oversight. In President Clinton's vision, oversight of the health care system was primarily a public responsibility, meaning that the government would have a significant role in regulating and overseeing the system. However, in today's reality, oversight of the health care system is more of a private responsibility, with private entities such as insurance companies and healthcare providers having more control and influence over the system.

This information is important to discuss with students because understanding health behaviors is crucial for community/public health nursing. By understanding health behaviors, students can develop strategies to promote healthy behaviors and prevent diseases in the community. This knowledge will enable them to effectively educate and empower individuals and communities to make informed decisions about their health. It will also help them in developing interventions and programs that address the specific health needs of the population they serve.

Managing third-party reimbursement is considered to be a responsibility of an insurance company. This involves the insurance company handling the process of reimbursing healthcare providers for services rendered to policyholders. This includes tasks such as verifying the eligibility of the policyholder, processing claims, and coordinating payments between the insurance company and the healthcare provider. By managing third-party reimbursement, the insurance company ensures that healthcare providers are properly compensated for their services and that policyholders receive the benefits they are entitled to.

HMOs operate by organizing a network of healthcare providers who offer services for a predetermined fee. This means that clients who are part of an HMO have access to a specific group of doctors, hospitals, and other healthcare providers who have agreed to provide services at a set cost. This arrangement helps to control costs and ensure that clients receive care within the network. It also allows for coordination of care and easier access to services, as clients do not need to search for providers on their own.

The conflict between the insurance company and the physician is most likely caused by a distribution of power issue. This suggests that there is a disagreement or imbalance in the authority and control between the two parties. It could be that the insurance company is exerting too much control over the physician's decisions or that the physician feels they are not being given enough power or autonomy in their practice. This power struggle is likely at the core of the conflict between the two entities.

The nurse would respond that the political influence held by those with a strong interest in maintaining the current system has prevented the implementation of a single-payer system. This implies that there are powerful individuals or groups who benefit from the current system and have the ability to prevent any significant changes. This explanation suggests that the obstacles to implementing a single-payer system are primarily political rather than practical or financial.

The most appropriate data for the nurse to use in examining the effectiveness of a health care system would be the health of the population served. This data would provide insights into the overall impact and outcomes of the system, indicating whether it is effectively promoting and maintaining the health of the population. It would help assess the system's ability to prevent and manage diseases, improve overall well-being, and address the healthcare needs of the population.

The U.S. Department of Health and Human Services is the correct answer because it is the federal agency that is most involved in both direct and indirect health-related responsibilities. It oversees a wide range of health-related programs and services, including public health, medical research, health insurance, and social services. It plays a critical role in protecting the health and well-being of all Americans and ensuring access to quality healthcare. The other options, such as the National Health Care Service Agency, Public Health Service, and Veterans Administration Medical Services Branch, may have health-related responsibilities but are not as extensively involved as the U.S. Department of Health and Human Services.

The most costly category of health care in the 1960s, which drastically increased after Medicare and Medicaid began, was hospital care. This can be attributed to the fact that Medicare and Medicaid provided coverage for hospital stays, leading to an increase in demand for hospital services and subsequently driving up the cost.

The nurse would have included information about how action plans are focused on changing lifestyles to reduce risks and prevent problems. This means that the goals of the national development are centered around promoting healthier behaviors and habits among individuals in order to prevent health issues. This approach recognizes the importance of addressing the root causes of health problems and promoting preventive measures rather than solely focusing on treatment and intervention.

The correct answer is b. There was a rise in the number of uninsured Americans. The Omnibus Budget Reconciliation Act of 1981 resulted in cuts to federal funding for Medicaid and other social welfare programs, leading to a decrease in access to affordable healthcare for many Americans. As a result, the number of uninsured individuals in the country increased.

The nurse would accurately state that there has been little progress in consolidating state health services into a single agency, as no state has completely achieved this goal.

The community/public health nurse would need to consult the client's physician because the physician serves as the primary care gatekeeper, who determines appropriate referrals. This means that the physician has the authority to decide if the client needs to be referred to a specialist or another healthcare provider for further evaluation or treatment. By consulting the physician, the nurse can ensure that the client receives the necessary and appropriate care from the appropriate healthcare professionals.

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The nurse would best describe the American health care system as being in the midst of ongoing change that offers real opportunities. This suggests that the system is not static but constantly evolving, which presents potential for improvement and advancement. It acknowledges that there are changes happening within the system, which can create opportunities for better healthcare outcomes and services.

The correct answer is d. The lowest life expectancy and highest infant mortality. This is because the U.S. health care system has been shown to have lower life expectancy and higher infant mortality rates compared to other similar industrialized countries. This could be due to various factors such as limited access to healthcare services, high healthcare costs, and disparities in healthcare coverage and quality.

This client would go to a publicly owned hospital to receive care because these hospitals are funded by the government and provide healthcare services to individuals who do not have the means to pay for private healthcare.

Nurses differ from most other professional health care providers because they are primarily employees of an organization. Unlike other healthcare professionals who may have their own private practice or work as independent contractors, nurses typically work within a healthcare organization such as a hospital, clinic, or nursing home. They are employed by these organizations and work as part of a larger healthcare team to provide care to patients. This distinction sets nurses apart from other healthcare providers in terms of their employment structure and relationship to the organization they work for.

In the 1960s, public health lost power and influence primarily because it had significantly reduced many life-threatening health problems. This means that the public health initiatives and interventions implemented during that time were successful in addressing and reducing various health issues that were previously considered life-threatening. As a result, the urgency and priority placed on public health decreased, leading to a decline in its power and influence.

Decreasing poverty levels is considered the best method to improve poor health according to economists, sociologists, and political activists. Poverty is often associated with limited access to healthcare, inadequate nutrition, and living conditions that can contribute to poor health outcomes. By addressing the root cause of poverty, it is believed that overall health in the community can be improved. Increasing funding to healthcare, increasing outpatient clinics, or decreasing the number of specialty physicians may address specific healthcare issues, but they may not necessarily address the underlying socioeconomic factors that contribute to poor health.

The U.S. health care system is described as decentralized because it is not under a single governing body or organization. Instead, it is comprised of various private and public entities, such as hospitals, clinics, insurance companies, and government programs. This decentralization often leads to a lack of coordination and inefficiencies in the system. Additionally, the U.S. health care system is known for being expensive, with high costs for medical services, medications, and insurance premiums. These factors contribute to the characterization of the U.S. health care system as decentralized and expensive.

The correct answer is d. Private system for those who can pay and public system for some of the poor. This answer accurately describes the two systems of healthcare that exist in the United States. The private system refers to healthcare services that are provided by private companies and are typically accessed by individuals who can afford to pay for them. The public system, on the other hand, refers to healthcare services that are provided by the government and are available to some low-income individuals who qualify for programs such as Medicaid.

Managed care models aim to ensure that the maximum value is obtained from the resources used in healthcare. This means that the focus is on optimizing the quality and efficiency of healthcare services while controlling costs. By implementing managed care, healthcare providers aim to provide the best possible care to patients while making efficient use of resources. This can involve strategies such as coordinating care, implementing evidence-based practices, and utilizing cost-effective treatments. Ultimately, the goal is to improve patient outcomes and satisfaction while maximizing the value of healthcare resources.

The client most likely has a preferred provider organization (PPO) health insurance plan. PPO plans typically have a looser organizational structure and do not require approval from a primary care physician before seeing a specialist. PPO plans allow clients to see any healthcare provider they choose, but offer higher coverage and lower out-of-pocket costs for services obtained from providers within the preferred network.

Each state health agency has many different departments, commissions, agencies, and boards. This information would likely be included because it highlights the complexity and diversity of the organizational structure within state health agencies. It suggests that these agencies are composed of various entities that work together to address public health concerns and provide services to citizens. This information is important for the elderly citizens to understand how the state health agency operates and the different components involved in its functioning.

The correct answer is c. Addressing needs that have been delegated by state health agencies. This responsibility would be discussed during the orientation of a recently hired community/public health nurse. It is important for the nurse to understand that the local health department works in collaboration with state health agencies and is responsible for addressing the needs that have been delegated to them. This ensures that the services provided by the local health department are aligned with the priorities and goals of the state health agencies.

The feature that is unique to the American Heart Association is using creative approaches to solve health problems. This means that the organization does not rely solely on traditional methods, but instead thinks outside the box to find innovative solutions to health issues. This could involve implementing new technologies, developing unique programs, or collaborating with other organizations to bring about positive change in the field of healthcare. By utilizing creative approaches, the American Heart Association is able to address health problems in a way that sets them apart from other organizations.

The federal government obtains its authority to be involved in health care from the regulation of interstate commerce and its responsibility to provide for the general welfare. This means that the government has the power to regulate health care activities that involve multiple states and to ensure the well-being of the general population. This authority is derived from the Constitution, which grants the federal government the power to regulate interstate commerce and promote the general welfare of the country.

The purpose of referring a client to the managed care service provided by the hospital is to review the care being provided and eliminate any unnecessary services. This ensures that the client is receiving the most appropriate and cost-effective care. By reviewing the care, the hospital can identify any services that may not be needed or could be replaced with more efficient alternatives. This helps to optimize the client's healthcare experience and reduce unnecessary costs.