Health Policy and Finance Overview
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Questions and Answers

Which statement accurately describes surprise billing in emergency services?

  • Surprise bills cannot exceed the patient's deductible amount.
  • Patients are never charged for out-of-network services in emergencies.
  • Patients might receive surprise bills for out-of-network services weeks after an emergency room visit. (correct)
  • Surprise billing is limited to in-network providers only.

    • What does Role Fidelity refer to in the context of healthcare?

  • Being faithful to one's scope of practice as a healthcare worker. (correct)
  • Being flexible in scope of practice to meet patient demands.
  • Prioritizing administrative tasks over patient care.
  • Taking on additional roles beyond one's designated practice.

    • How does global budgeting impact healthcare coordination?

  • It focuses on increasing the number of emergency services available.
  • It encourages care coordination and cost reduction for the healthcare system. (correct)
  • It allows for unlimited spending on patient care.
  • It maximizes hospital profits by minimizing costs.

    • What is a deductible in health insurance?

    <p>An amount that must be paid by the patient before insurance coverage kicks in.</p> Signup and view all the answers

    What is a Certificate of Need?

    <p>A regulatory document that physicians require to establish a new facility.</p> Signup and view all the answers

    Which of the following best defines antitrust laws in healthcare?

    <p>They are designed to prevent companies from dominating the market.</p> Signup and view all the answers

    What impact does cost-sharing have on patients?

    <p>It involves multiple payment types such as deductibles, co-payments, and coinsurance.</p> Signup and view all the answers

    What are nurse-sensitive indicators?

    <p>Quality outcomes influenced by nursing activities, such as safety measures.</p> Signup and view all the answers

    Why might some healthcare facilities struggle to survive despite state or federal support?

    <p>Due to a lack of patient demand and revenue streams.</p> Signup and view all the answers

    What is a significant misconception about high-cost health insurance?

    <p>More expensive insurance plans do not always offer superior benefits.</p> Signup and view all the answers

    What is the implication of not publishing prices by acute care hospitals?

    <p>Hospitals can charge patients without any market competition.</p> Signup and view all the answers

    How does Role Fidelity apply in the context of a patient’s request?

    <p>Nurses are obligated to honor a request for confidentiality.</p> Signup and view all the answers

    What is a key characteristic of global budgeting in healthcare?

    <p>It aligns provider incentives with patient care coordination.</p> Signup and view all the answers

    What can be a potential consequence of antitrust laws not preventing market dominance?

    <p>Higher costs for consumers due to lack of competition.</p> Signup and view all the answers

    How does the deductible function in a health insurance plan?

    <p>It is an upfront amount the patient must pay before insurance coverage kicks in.</p> Signup and view all the answers

    What does the concept of cost sharing entail?

    <p>Division of healthcare costs between the patient and their insurance.</p> Signup and view all the answers

    In what scenario might surprise billing occur?

    <p>When out of network services are provided unexpectedly during emergency care.</p> Signup and view all the answers

    What is an example of a nurse-sensitive indicator?

    <p>Safety measures implemented within the hospital.</p> Signup and view all the answers

    What is a significant reason for providing a Certificate of Need?

    <p>To ensure that healthcare facilities exist in neighborhoods where they are needed.</p> Signup and view all the answers

    What is a potential outcome of providers not being accountable for positive outcomes?

    <p>Deterioration in patient health and greater healthcare costs.</p> Signup and view all the answers

    What does the term 'Role Fidelity' mean in healthcare?

    <p>Being faithful to the scope of practice</p> Signup and view all the answers

    What is a negative consequence of acute care hospitals not publishing their prices?

    <p>Patients may have difficulty comparing costs and making informed decisions</p> Signup and view all the answers

    What does the DRG (Diagnosis Related Group) system primarily affect?

    <p>Length of hospital stays and treatment protocols</p> Signup and view all the answers

    Which of the following describes the impact of global budgeting in healthcare?

    <p>Decreased healthcare costs through better resource allocation</p> Signup and view all the answers

    What role does a deductible play in health insurance for patients?

    <p>It is a fixed sum that patients pay before insurance coverage begins</p> Signup and view all the answers

    How do surprise billing practices typically occur?

    <p>When a patient requests an in-network provider but is seen by an out-of-network specialist</p> Signup and view all the answers

    What is one potential impact of antitrust laws not being enforced in healthcare?

    <p>Dominance of certain healthcare providers, reducing market choices</p> Signup and view all the answers

    What is a key aspect of cost sharing in health insurance?

    <p>Patients are responsible for some portion of their healthcare costs</p> Signup and view all the answers

    What challenge do some healthcare facilities face despite receiving state or federal support?

    <p>Inability to survive independently due to low patient volume</p> Signup and view all the answers

    How do nurse-sensitive indicators contribute to healthcare quality?

    <p>They reflect variables that can be improved through nursing care</p> Signup and view all the answers

    Study Notes

    Health Policy and Finance Overview

    • Large companies can negotiate lower contract rates for healthcare services for their employees.
    • Acute care hospitals often do not disclose prices, hindering patient price comparisons for services.
    • Patients can receive surprise bills for out-of-network services after emergency room visits, even weeks later.
    • Safety measures are an example of nurse-sensitive indicators that reflect quality of care.
    • The Joint Commission does not conduct comparative inspections of inpatient and outpatient services regarding costs and payments.
    • Coordinating care often relies on the patient's Electronic Health Record (EHR) for accurate information.
    • Higher costs for healthcare insurance do not guarantee better coverage or services.
    • Antitrust laws fail to fully prevent market domination by companies that limit competition.
    • Some healthcare facilities are unsustainable even with state or federal financial support.
    • A Certificate of Need is required for a group of physicians seeking state approval to open a new facility.
    • Role Fidelity denotes adherence to the scope of practice relevant to all healthcare professionals.
    • An example of Role Fidelity: a nurse respecting a patient's wish not to disclose a terminal illness to family.
    • Global budgeting promotes care coordination while incentivizing cost reduction in healthcare.
    • Accountability for positive health outcomes is a method to improve population health.
    • Managing services and treatments exemplifies acting in the best interest of patients.
    • A deductible is the out-of-pocket amount a patient must pay before their insurance covers further costs.
    • Cost sharing encompasses deductibles, copayments, and coinsurance payments.
    • Diagnosis Related Groups (DRGs) help provide extended treatment and extra days for hospitalized patients.
    • The Affordable Care Act (ACA) is financed through multiple channels, including public funding from a single-payer system.
    • Coinsurance represents a percentage of healthcare costs the patient pays after meeting the deductible, such as 20% with the insurance covering the remainder.
    • Healthcare disparity indicates unequal access and treatment among different populations.
    • Major sources of healthcare financing in the U.S. include Medicare, Medicaid, federal taxes, and commercial insurance.

    Health Policy and Finance Overview

    • Large companies can negotiate lower contract rates for healthcare services for their employees.
    • Acute care hospitals often do not disclose prices, hindering patient price comparisons for services.
    • Patients can receive surprise bills for out-of-network services after emergency room visits, even weeks later.
    • Safety measures are an example of nurse-sensitive indicators that reflect quality of care.
    • The Joint Commission does not conduct comparative inspections of inpatient and outpatient services regarding costs and payments.
    • Coordinating care often relies on the patient's Electronic Health Record (EHR) for accurate information.
    • Higher costs for healthcare insurance do not guarantee better coverage or services.
    • Antitrust laws fail to fully prevent market domination by companies that limit competition.
    • Some healthcare facilities are unsustainable even with state or federal financial support.
    • A Certificate of Need is required for a group of physicians seeking state approval to open a new facility.
    • Role Fidelity denotes adherence to the scope of practice relevant to all healthcare professionals.
    • An example of Role Fidelity: a nurse respecting a patient's wish not to disclose a terminal illness to family.
    • Global budgeting promotes care coordination while incentivizing cost reduction in healthcare.
    • Accountability for positive health outcomes is a method to improve population health.
    • Managing services and treatments exemplifies acting in the best interest of patients.
    • A deductible is the out-of-pocket amount a patient must pay before their insurance covers further costs.
    • Cost sharing encompasses deductibles, copayments, and coinsurance payments.
    • Diagnosis Related Groups (DRGs) help provide extended treatment and extra days for hospitalized patients.
    • The Affordable Care Act (ACA) is financed through multiple channels, including public funding from a single-payer system.
    • Coinsurance represents a percentage of healthcare costs the patient pays after meeting the deductible, such as 20% with the insurance covering the remainder.
    • Healthcare disparity indicates unequal access and treatment among different populations.
    • Major sources of healthcare financing in the U.S. include Medicare, Medicaid, federal taxes, and commercial insurance.

    Health Policy and Finance Overview

    • Large companies can negotiate lower contract rates for healthcare services for their employees.
    • Acute care hospitals often do not disclose prices, hindering patient price comparisons for services.
    • Patients can receive surprise bills for out-of-network services after emergency room visits, even weeks later.
    • Safety measures are an example of nurse-sensitive indicators that reflect quality of care.
    • The Joint Commission does not conduct comparative inspections of inpatient and outpatient services regarding costs and payments.
    • Coordinating care often relies on the patient's Electronic Health Record (EHR) for accurate information.
    • Higher costs for healthcare insurance do not guarantee better coverage or services.
    • Antitrust laws fail to fully prevent market domination by companies that limit competition.
    • Some healthcare facilities are unsustainable even with state or federal financial support.
    • A Certificate of Need is required for a group of physicians seeking state approval to open a new facility.
    • Role Fidelity denotes adherence to the scope of practice relevant to all healthcare professionals.
    • An example of Role Fidelity: a nurse respecting a patient's wish not to disclose a terminal illness to family.
    • Global budgeting promotes care coordination while incentivizing cost reduction in healthcare.
    • Accountability for positive health outcomes is a method to improve population health.
    • Managing services and treatments exemplifies acting in the best interest of patients.
    • A deductible is the out-of-pocket amount a patient must pay before their insurance covers further costs.
    • Cost sharing encompasses deductibles, copayments, and coinsurance payments.
    • Diagnosis Related Groups (DRGs) help provide extended treatment and extra days for hospitalized patients.
    • The Affordable Care Act (ACA) is financed through multiple channels, including public funding from a single-payer system.
    • Coinsurance represents a percentage of healthcare costs the patient pays after meeting the deductible, such as 20% with the insurance covering the remainder.
    • Healthcare disparity indicates unequal access and treatment among different populations.
    • Major sources of healthcare financing in the U.S. include Medicare, Medicaid, federal taxes, and commercial insurance.

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    Description

    This quiz explores key aspects of health policy and finance, focusing on the negotiation of healthcare service rates, transparency issues regarding hospital pricing, and the implications of surprise billing. Additionally, it touches on the role of electronic health records in care coordination and the effects of antitrust laws on market competition. Test your knowledge on these critical healthcare topics.

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