Nursing Midterm Review
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Questions and Answers

In the healthcare system, healthy people carry the costs for sick people.

True

What is Pay for Performance (P4P)?

A model for payments that provides monetary incentives to doctors who meet quality care standards.

Nursing care services are paid based on the type of room/unit the patient stays in.

True

Who provides health insurance to most privately insured Americans?

<p>Employers</p> Signup and view all the answers

What are the roles of the federal government in the US healthcare system?

<p>Finance, regulate and reimburse.</p> Signup and view all the answers

What is required for a truly free healthcare market?

<p>Accurate and transparent information for patients.</p> Signup and view all the answers

What does DRG stand for?

<p>Diagnosis Related Group.</p> Signup and view all the answers

What was the purpose of creating Medicare in 1955?

<p>To provide healthcare for those over 65.</p> Signup and view all the answers

Match the following social determinants of health with their descriptions:

<p>Genetics = Inherited traits that may affect health. Access to care = Ability to obtain necessary healthcare services.</p> Signup and view all the answers

What did the Flexner Report do for the profession of nursing?

<p>Did not assist the profession</p> Signup and view all the answers

Essential Health Benefits under ACA include which of the following?

<p>Pediatric Services</p> Signup and view all the answers

What should individuals with high deductible insurance consider?

<p>How much healthcare they might need.</p> Signup and view all the answers

Who could be professionals in a patient-centered medical home?

<p>All of the above</p> Signup and view all the answers

An example of reimbursements for patient outcomes includes:

<p>Re-admission with heart failure</p> Signup and view all the answers

The Affordable Care Act of 2010 passed strategies to destabilize the health insurance market.

<p>False</p> Signup and view all the answers

Hospitals and healthcare organizations are monitored to ensure they provide safe and quality patient care.

<p>True</p> Signup and view all the answers

What is a deductible?

<p>An amount of money established by the insurance company to be paid by the patient.</p> Signup and view all the answers

Cost sharing includes which of the following?

<p>All of the above</p> Signup and view all the answers

What are the three main goals of the Affordable Care Act (ACA)?

<p>Expand Medicaid</p> Signup and view all the answers

Patients make co-payments through their employer.

<p>False</p> Signup and view all the answers

The DRG model provides for prolonged treatments and extra days for patients in the hospital.

<p>False</p> Signup and view all the answers

Patient-centered medical homes are characterized by uncoordinated care.

<p>False</p> Signup and view all the answers

In what ways is the ACA financed?

<p>Through public funding, employer mandates, and individual mandates.</p> Signup and view all the answers

Out-of-pocket cost sharing increases consumer awareness and cost-consciousness regarding healthcare.

<p>True</p> Signup and view all the answers

What does coordinated care for patients hospitalized with Congested Heart Failure include?

<p>All of the above</p> Signup and view all the answers

What is coinsurance?

<p>The percentage of covered health costs the patient is responsible for paying after meeting their deductible.</p> Signup and view all the answers

What is an example of a controlled market?

<p>A market regulated by the government.</p> Signup and view all the answers

Which of the following are included in the ACA financing model?

<p>Public Funding through Taxes</p> Signup and view all the answers

What is a catastrophic plan?

<p>An insurance option for healthy patients under age 30 who cannot find affordable coverage.</p> Signup and view all the answers

Healthcare in the US is known for low technology care.

<p>False</p> Signup and view all the answers

What is Fee for Service (FFS)?

<p>A payment model that pays for specific items and services used during hospitalization.</p> Signup and view all the answers

The Affordable Care Act allows lifetime caps on health costs and benefits.

<p>False</p> Signup and view all the answers

What does autonomy mean in healthcare?

<p>The patient has the right to make their healthcare decisions.</p> Signup and view all the answers

What does beneficence mean?

<p>An act of charity, doing good to others.</p> Signup and view all the answers

What does disparity in healthcare mean?

<p>It is not fairly given to all people.</p> Signup and view all the answers

One way to determine a good health outcome for the US is to address compliance with healthy behavior.

<p>True</p> Signup and view all the answers

Social determinants of health include which of the following?

<p>All of the above</p> Signup and view all the answers

Patients may pay increased prices for healthcare coverage if they smoke tobacco.

<p>True</p> Signup and view all the answers

What were some original ACA financing models?

<p>Employer insurance mandates</p> Signup and view all the answers

How is healthcare in the US mostly financed?

<p>Medicaid</p> Signup and view all the answers

The Patient Protection and Affordable Care Act includes strategies to stabilize the healthcare market.

<p>True</p> Signup and view all the answers

What do reimbursements include?

<p>Patient co-payments</p> Signup and view all the answers

What are some negative aspects of the healthcare system?

<p>Expensive prices</p> Signup and view all the answers

Study Notes

Health Insurance Dynamics

  • Healthy individuals bear the costs of care for those who are ill within the health insurance system.
  • Most privately insured Americans receive their health insurance through their employers.

Payment Models in Healthcare

  • Pay for Performance (P4P) incentivizes doctors financially to meet quality care standards.
  • Diagnosis Related Groups (DRG) establish payment per admission based on diagnosis, influencing hospital stays.

Government's Role in Healthcare

  • The federal government finances, regulates, and reimburses healthcare services in the US.
  • The Affordable Care Act (ACA) aims to expand Medicaid, control healthcare costs, and promote preventive health measures.

Essential Health Benefits

  • Essential health benefits under the ACA include mental health services, pediatric services, and emergency services.

Cost Sharing and Insurance Terms

  • Patients must pay a deductible set by insurance companies before coverage begins.
  • Cost-sharing can involve deductibles, co-payments, and coinsurance payments.

Patient-Centered Medical Homes

  • Patient-centered medical homes focus on coordinated care to control healthcare costs.

ACA Financing

  • The ACA is financed through public funding, individual mandates, and employer mandates.
  • Financing models include employer insurance mandates and public funding via taxes.

Professional Roles in Healthcare

  • Patient-centered medical homes may include doctors, nurses, dieticians, and home health nurses as part of coordinated care teams.

Health Disparities and Determinants

  • Disparities in healthcare indicate unequal access and quality of care for different populations.
  • Social determinants of health are influenced by factors such as power, global resources, money, and local/national resources.

Reimbursement Challenges

  • Reimbursement models are critical for ensuring that care providers are paid fairly, but inconsistencies in quality and costs can lead to over-treatment or under-treatment.

Patient Rights and Ethical Considerations

  • Autonomy allows patients the right to make their healthcare decisions, while beneficence involves acting in the patient’s best interests.

Additional Healthcare Insights

  • A catastrophic insurance plan is an option for healthy individuals under 30 who cannot find affordable insurance.
  • Smoking tobacco may lead to higher healthcare costs for individuals due to associated health risks.

Evaluating US Healthcare

  • Effective healthcare evaluation includes compliance with healthy behaviors and monitoring for quality and safety in patient care.

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Description

Prepare for your nursing midterm with this comprehensive review. The quiz covers essential topics such as health insurance dynamics and payment models like Pay for Performance. Test your knowledge on nursing care services and improve your understanding before the big exam.

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