Podcast
Questions and Answers
What percentage of the gross domestic product was spent on health care expenditures in the United States in 2018?
What percentage of the gross domestic product was spent on health care expenditures in the United States in 2018?
How many Americans did not have health insurance in the first 6 months of 2020?
How many Americans did not have health insurance in the first 6 months of 2020?
What is the primary focus of the nursing profession?
What is the primary focus of the nursing profession?
What is a consequence of not having health insurance or delaying health care?
What is a consequence of not having health insurance or delaying health care?
Signup and view all the answers
What is the average annual health care expenditure per person in the United States?
What is the average annual health care expenditure per person in the United States?
Signup and view all the answers
What is a key aspect of nursing's focus on health care consumers?
What is a key aspect of nursing's focus on health care consumers?
Signup and view all the answers
Why do millions of Americans with health insurance not seek preventive or needed health care?
Why do millions of Americans with health insurance not seek preventive or needed health care?
Signup and view all the answers
What is the value of the nursing profession?
What is the value of the nursing profession?
Signup and view all the answers
What is the main challenge posed by the aging baby boomer generation to the healthcare system?
What is the main challenge posed by the aging baby boomer generation to the healthcare system?
Signup and view all the answers
What is the consequence of the accelerating rate of nurses' retirements?
What is the consequence of the accelerating rate of nurses' retirements?
Signup and view all the answers
What is the focus of health-related activities in a care setting?
What is the focus of health-related activities in a care setting?
Signup and view all the answers
What is the primary role of a nurse in a primary care setting?
What is the primary role of a nurse in a primary care setting?
Signup and view all the answers
What is the main difference between levels of care and levels of prevention?
What is the main difference between levels of care and levels of prevention?
Signup and view all the answers
What is the impact of health care reform on the health care industry?
What is the impact of health care reform on the health care industry?
Signup and view all the answers
What is the role of a nurse in wellness care?
What is the role of a nurse in wellness care?
Signup and view all the answers
What is the primary goal of developing clinical judgment in nursing?
What is the primary goal of developing clinical judgment in nursing?
Signup and view all the answers
What is the role of a nurse in a continuing care setting?
What is the role of a nurse in a continuing care setting?
Signup and view all the answers
What is the consequence of the shortage and uneven distribution of physicians?
What is the consequence of the shortage and uneven distribution of physicians?
Signup and view all the answers
What was the primary focus of developing Integrated Health Care Delivery (IHCD) systems?
What was the primary focus of developing Integrated Health Care Delivery (IHCD) systems?
Signup and view all the answers
What is the goal of focusing on population health in IHCD systems?
What is the goal of focusing on population health in IHCD systems?
Signup and view all the answers
What is an example of an Integrated Health Care Delivery (IHCD) system?
What is an example of an Integrated Health Care Delivery (IHCD) system?
Signup and view all the answers
How many types of IHCDs exist?
How many types of IHCDs exist?
Signup and view all the answers
What is the primary function of a Patient-Centered Medical Home?
What is the primary function of a Patient-Centered Medical Home?
Signup and view all the answers
What is a unifying principle of Patient-Centered Medical Home?
What is a unifying principle of Patient-Centered Medical Home?
Signup and view all the answers
What is included in the organizational structure of IHCDs that follows economic imperatives?
What is included in the organizational structure of IHCDs that follows economic imperatives?
Signup and view all the answers
What is the purpose of electronic health records (EHRs) in Patient-Centered Medical Home?
What is the purpose of electronic health records (EHRs) in Patient-Centered Medical Home?
Signup and view all the answers
What type of care is included in secondary care services?
What type of care is included in secondary care services?
Signup and view all the answers
What is the primary goal of Integrated Health Care Delivery (IHCD) systems?
What is the primary goal of Integrated Health Care Delivery (IHCD) systems?
Signup and view all the answers
What is the main focus of primary health care?
What is the main focus of primary health care?
Signup and view all the answers
What is the primary goal of health promotion programs?
What is the primary goal of health promotion programs?
Signup and view all the answers
Who leads a team of professionals dedicated to providing proactive, preventive, and chronic care management?
Who leads a team of professionals dedicated to providing proactive, preventive, and chronic care management?
Signup and view all the answers
What is the main difference between secondary and tertiary care?
What is the main difference between secondary and tertiary care?
Signup and view all the answers
What is the primary reason people use health care services, such as a hospital?
What is the primary reason people use health care services, such as a hospital?
Signup and view all the answers
What is the main goal of preventive care?
What is the main goal of preventive care?
Signup and view all the answers
What is the primary source of referral for secondary health care?
What is the primary source of referral for secondary health care?
Signup and view all the answers
What is the primary characteristic of tertiary health care?
What is the primary characteristic of tertiary health care?
Signup and view all the answers
What is the primary consequence of delays in treating or diagnosing chronic illness?
What is the primary consequence of delays in treating or diagnosing chronic illness?
Signup and view all the answers
What is the main function of hospitals?
What is the main function of hospitals?
Signup and view all the answers
What percentage of adults in the United States with a mental health condition received mental health services in 2019?
What percentage of adults in the United States with a mental health condition received mental health services in 2019?
Signup and view all the answers
Which type of service integrates health promotion principles into a school curriculum?
Which type of service integrates health promotion principles into a school curriculum?
Signup and view all the answers
What is the primary goal of occupational health services?
What is the primary goal of occupational health services?
Signup and view all the answers
What type of service focuses on health promotion and health education, chronic disease assessment and management, and support for self-care and caregivers?
What type of service focuses on health promotion and health education, chronic disease assessment and management, and support for self-care and caregivers?
Signup and view all the answers
What is a unique aspect of block and parish nursing?
What is a unique aspect of block and parish nursing?
Signup and view all the answers
What is a key feature of community centers?
What is a key feature of community centers?
Signup and view all the answers
Which type of service provides primary health care and diagnoses and treats acute and chronic illnesses?
Which type of service provides primary health care and diagnoses and treats acute and chronic illnesses?
Signup and view all the answers
What is a common service offered by nurse-managed clinics?
What is a common service offered by nurse-managed clinics?
Signup and view all the answers
Why are school health services important?
Why are school health services important?
Signup and view all the answers
What is a unique aspect of community centers?
What is a unique aspect of community centers?
Signup and view all the answers
What is the primary difference between Critical Access Hospitals (CAHs) and large urban medical centers?
What is the primary difference between Critical Access Hospitals (CAHs) and large urban medical centers?
Signup and view all the answers
What is the role of clinical judgment in delivering patient care?
What is the role of clinical judgment in delivering patient care?
Signup and view all the answers
What is the core mission of hospitals across the country?
What is the core mission of hospitals across the country?
Signup and view all the answers
What is a key aspect of patient-centered care?
What is a key aspect of patient-centered care?
Signup and view all the answers
What is a characteristic of Intensive Care Units (ICUs)?
What is a characteristic of Intensive Care Units (ICUs)?
Signup and view all the answers
What is the primary focus of mental health facilities?
What is the primary focus of mental health facilities?
Signup and view all the answers
What is the role of evidence-based practice guidelines in hospitals?
What is the role of evidence-based practice guidelines in hospitals?
Signup and view all the answers
What is a challenge of delivering patient care in a stressful setting?
What is a challenge of delivering patient care in a stressful setting?
Signup and view all the answers
What is the role of nurses in patient-centered care?
What is the role of nurses in patient-centered care?
Signup and view all the answers
What is the purpose of quality initiatives in hospitals?
What is the purpose of quality initiatives in hospitals?
Signup and view all the answers
What is the primary purpose of a Critical Access Hospital (CAH)?
What is the primary purpose of a Critical Access Hospital (CAH)?
Signup and view all the answers
What is the role of advanced practice nurses in rural healthcare?
What is the role of advanced practice nurses in rural healthcare?
Signup and view all the answers
Why is discharge planning important in rural healthcare?
Why is discharge planning important in rural healthcare?
Signup and view all the answers
What is the goal of discharge planning in rural healthcare?
What is the goal of discharge planning in rural healthcare?
Signup and view all the answers
What is the role of nurses in discharge planning?
What is the role of nurses in discharge planning?
Signup and view all the answers
What is the consequence of 'quicker and sicker' discharges from hospitals?
What is the consequence of 'quicker and sicker' discharges from hospitals?
Signup and view all the answers
What is the role of case managers or social workers in discharge planning?
What is the role of case managers or social workers in discharge planning?
Signup and view all the answers
What is the focus of rural healthcare systems?
What is the focus of rural healthcare systems?
Signup and view all the answers
What is the role of healthcare payers in rural healthcare?
What is the role of healthcare payers in rural healthcare?
Signup and view all the answers
What is the purpose of discharge planning in rural healthcare?
What is the purpose of discharge planning in rural healthcare?
Signup and view all the answers
What is the primary goal of discharge planning?
What is the primary goal of discharge planning?
Signup and view all the answers
Who is responsible for identifying a patient's continuing needs before discharge?
Who is responsible for identifying a patient's continuing needs before discharge?
Signup and view all the answers
What is a benefit of a nurse-driven discharge planning model?
What is a benefit of a nurse-driven discharge planning model?
Signup and view all the answers
Why is it essential to communicate clearly about the plan of care with patients, families, and healthcare team members?
Why is it essential to communicate clearly about the plan of care with patients, families, and healthcare team members?
Signup and view all the answers
What is a barrier to effective discharge planning?
What is a barrier to effective discharge planning?
Signup and view all the answers
Why is it important to involve patients and family caregivers in discharge planning?
Why is it important to involve patients and family caregivers in discharge planning?
Signup and view all the answers
What is the purpose of discharge instructions?
What is the purpose of discharge instructions?
Signup and view all the answers
When should discharge instructions be provided?
When should discharge instructions be provided?
Signup and view all the answers
What is the primary goal of comprehensive discharge instruction?
What is the primary goal of comprehensive discharge instruction?
Signup and view all the answers
What is the focus of the teach-back approach?
What is the focus of the teach-back approach?
Signup and view all the answers
What is a factor that may affect a patient's ability to learn during discharge planning?
What is a factor that may affect a patient's ability to learn during discharge planning?
Signup and view all the answers
Which patients are more in need of discharge planning?
Which patients are more in need of discharge planning?
Signup and view all the answers
What is the purpose of referrals to other health care providers?
What is the purpose of referrals to other health care providers?
Signup and view all the answers
What is the role of the transition coach in Coleman's 'Care Transitions Program'?
What is the role of the transition coach in Coleman's 'Care Transitions Program'?
Signup and view all the answers
What is the primary focus of Naylor's 'Transitional Care Model'?
What is the primary focus of Naylor's 'Transitional Care Model'?
Signup and view all the answers
What is the goal of the High-Intensity Care Model (GRACE Model)?
What is the goal of the High-Intensity Care Model (GRACE Model)?
Signup and view all the answers
Why is it important to engage patients and family caregivers in the referral process?
Why is it important to engage patients and family caregivers in the referral process?
Signup and view all the answers
What is a key aspect of the teach-back approach?
What is a key aspect of the teach-back approach?
Signup and view all the answers
What is the goal of comprehensive discharge planning?
What is the goal of comprehensive discharge planning?
Signup and view all the answers
What is the primary focus of discharge instruction?
What is the primary focus of discharge instruction?
Signup and view all the answers
What is the primary goal of restorative care?
What is the primary goal of restorative care?
Signup and view all the answers
Why is it important to give the care provider receiving the referral as much information as possible about the patient?
Why is it important to give the care provider receiving the referral as much information as possible about the patient?
Signup and view all the answers
What is the primary focus of home care?
What is the primary focus of home care?
Signup and view all the answers
What is the role of the restorative health care team?
What is the role of the restorative health care team?
Signup and view all the answers
What is the purpose of the OASIS assessment?
What is the purpose of the OASIS assessment?
Signup and view all the answers
What is the primary role of a home care nurse?
What is the primary role of a home care nurse?
Signup and view all the answers
Why is early collaboration with patients and their families important in restorative care?
Why is early collaboration with patients and their families important in restorative care?
Signup and view all the answers
What is the primary focus of restorative care in a rehabilitation setting?
What is the primary focus of restorative care in a rehabilitation setting?
Signup and view all the answers
What is the primary goal of providing restorative care to patients in a home setting?
What is the primary goal of providing restorative care to patients in a home setting?
Signup and view all the answers
What is the importance of a clear understanding of goals for physical recovery in restorative care?
What is the importance of a clear understanding of goals for physical recovery in restorative care?
Signup and view all the answers
What type of care do patients with mental illness receive in a hospital setting?
What type of care do patients with mental illness receive in a hospital setting?
Signup and view all the answers
What is the primary reason for the lack of access to healthcare in rural areas?
What is the primary reason for the lack of access to healthcare in rural areas?
Signup and view all the answers
What is the result of the massive cuts to non-Medicaid state mental health spending in 2011?
What is the result of the massive cuts to non-Medicaid state mental health spending in 2011?
Signup and view all the answers
What is the purpose of a Critical Access Hospital (CAH)?
What is the purpose of a Critical Access Hospital (CAH)?
Signup and view all the answers
What is a consequence of individuals with serious mental illnesses not receiving proper care?
What is a consequence of individuals with serious mental illnesses not receiving proper care?
Signup and view all the answers
What is the role of a comprehensive interprofessional treatment plan in a hospital setting?
What is the role of a comprehensive interprofessional treatment plan in a hospital setting?
Signup and view all the answers
What is the percentage of physicians who practice in rural America?
What is the percentage of physicians who practice in rural America?
Signup and view all the answers
What is the name of the act that changed the designation of some rural hospitals to Critical Access Hospital (CAH)?
What is the name of the act that changed the designation of some rural hospitals to Critical Access Hospital (CAH)?
Signup and view all the answers
What is the purpose of referrals for follow-up care at clinics or with counselors during discharge from inpatient settings?
What is the purpose of referrals for follow-up care at clinics or with counselors during discharge from inpatient settings?
Signup and view all the answers
What type of facilities offer inpatient and outpatient services for mental health care?
What type of facilities offer inpatient and outpatient services for mental health care?
Signup and view all the answers
What is the primary goal of home health care?
What is the primary goal of home health care?
Signup and view all the answers
What is the purpose of the OASIS assessment tool?
What is the purpose of the OASIS assessment tool?
Signup and view all the answers
What is the focus of rehabilitation?
What is the focus of rehabilitation?
Signup and view all the answers
What is the purpose of rehabilitation services after acute care?
What is the purpose of rehabilitation services after acute care?
Signup and view all the answers
What is the primary focus of home care agencies?
What is the primary focus of home care agencies?
Signup and view all the answers
What is the purpose of rehabilitation in the home setting?
What is the purpose of rehabilitation in the home setting?
Signup and view all the answers
What is the focus of rehabilitation programs?
What is the focus of rehabilitation programs?
Signup and view all the answers
What is the goal of rehabilitation in patients with severe disabilities?
What is the goal of rehabilitation in patients with severe disabilities?
Signup and view all the answers
What is the purpose of rehabilitation services?
What is the purpose of rehabilitation services?
Signup and view all the answers
What is the goal of rehabilitation after acute care?
What is the goal of rehabilitation after acute care?
Signup and view all the answers
What is the primary purpose of an extended care facility?
What is the primary purpose of an extended care facility?
Signup and view all the answers
What type of care is provided in an intermediate care or skilled nursing facility?
What type of care is provided in an intermediate care or skilled nursing facility?
Signup and view all the answers
What is the focus of continuing care services?
What is the focus of continuing care services?
Signup and view all the answers
What type of services are provided in nursing centers?
What type of services are provided in nursing centers?
Signup and view all the answers
What is the purpose of elder care services?
What is the purpose of elder care services?
Signup and view all the answers
What is the primary goal of nursing centers?
What is the primary goal of nursing centers?
Signup and view all the answers
What type of care is provided in extended care facilities?
What type of care is provided in extended care facilities?
Signup and view all the answers
What is the main reason for the growing need for intermediate care settings?
What is the main reason for the growing need for intermediate care settings?
Signup and view all the answers
What is included in the services provided by Medicaid-certified nursing homes?
What is included in the services provided by Medicaid-certified nursing homes?
Signup and view all the answers
What is the primary goal of continuing care services?
What is the primary goal of continuing care services?
Signup and view all the answers
What is the primary focus of a skilled nursing facility?
What is the primary focus of a skilled nursing facility?
Signup and view all the answers
What is a characteristic of nursing centers?
What is a characteristic of nursing centers?
Signup and view all the answers
What is a requirement for nursing facilities to receive payment from Medicare and Medicaid?
What is a requirement for nursing facilities to receive payment from Medicare and Medicaid?
Signup and view all the answers
What type of approach to care is used in nursing centers?
What type of approach to care is used in nursing centers?
Signup and view all the answers
What is the goal of care in nursing centers?
What is the goal of care in nursing centers?
Signup and view all the answers
What type of services are provided in nursing centers?
What type of services are provided in nursing centers?
Signup and view all the answers
Study Notes
U.S. Health Care System
- Complex and constantly changing
- Focus on reducing costs, improving access, and ensuring high-quality outcomes
- 30 million Americans lacked health insurance in 2020 (Assistant Secretary for Planning and Evaluation, 2021)
- Health care expenditures in the United States totaled 17.7% of the gross domestic product in 2018, averaging $11,172 per person (Centers for Medicare and Medicaid Services, 2019a)
Nursing Profession
- Rooted in helping people regain, maintain, or improve their health
- Focus on preventing illness and finding comfort and dignity at the end of life
- Nursing promotes health, well-being, comfort, dignity, and humanity of all individuals, families, groups, communities, and populations (American Nurses Association, 2021)
- Challenges facing nursing include:
- Aging baby boomer generation
- Shortage and uneven distribution of physicians
- Accelerating rate of nurses' retirements
- Uncertainty of health care reform
Levels of Health Care
- Six levels of care:
- Preventive care
- Primary care
- Secondary care
- Tertiary care
- Restorative care
- Continuing care
- Each level presents different requirements and opportunities for nurses
- Levels of care are not the same as levels of prevention (see Chapter 6)
Integrated Health Care Delivery
- Developed as part of the U.S. health care reform movement
- Aims to provide a continuum of health services to a defined population
- Goals include:
- Improving health care quality
- Decreasing overall health care costs
- Focusing on population health
- Examples include:
- Accountable Care Organizations (ACOs)
- Patient-Centered Medical Home model
Primary and Preventive Health Care Services
- Primary health care focuses on improved health outcomes for an entire population
- Primary health care services include:
- Regular health care visits
- Health education
- Proper nutrition
- Maternal/child health care
- Family planning
- Immunizations
- Control of diseases
- Health promotion programs are designed to reduce the incidence of disease and minimize complications
Secondary and Tertiary Care
- Secondary health care is provided by a specialist or agency on referral by a primary health care provider
- Tertiary health care is specialized consultative care, usually provided on referral from secondary medical personnel
- Examples of secondary and tertiary care include:
- Hospital emergency care
- Intensive care units (ICUs)
- Specialty care (e.g., cardiology, neurology, oncology)### Clinics and Community Centers
- Clinics are often associated with schools, colleges, departments of nursing, federally qualified health centers, or independent nonprofit health care agencies.
- Services provided by clinics include:
- Diabetes screenings
- Smoking cessation programs
- Immunizations
- Physical examinations
- Cardiovascular checks
- Health risk appraisal
- Wellness counseling
- Employment readiness
- Acute and chronic care management
- Community centers provide comprehensive and cost-effective primary care and supportive services to promote access to health care.
- Services provided by community centers include:
- Physical assessment and health screening
- Nutrition education
- Translation services
- Dental care
- Mental health services
- Care coordination and case management
- Specialty care (e.g., orthopedic, cardiac, or podiatric care)
- Disease management
- Health education
Mental Health Services
- Mental health facilities are located in hospitals, independent outpatient clinics, and private mental health hospitals.
- Services provided by mental health facilities include:
- Inpatient and outpatient services
- Voluntary and involuntary admission
- Patients who are hospitalized usually have short stays intended to stabilize them before transfer to outpatient treatment centers.
- Patients with mental illness receive a comprehensive interprofessional treatment plan that engages patients and their families.
Rural Hospitals
- Rural hospitals face challenges in providing access to health care due to factors such as:
- Economic factors (e.g., poverty)
- Cultural and social differences
- Educational shortcomings
- Lack of recognition by legislators
- Isolation from living in remote rural areas
- To address these challenges, some rural hospitals have been designated as Critical Access Hospitals (CAHs).
- CAHs provide 24/7 emergency services, have no more than 25 inpatient beds, and report an average length of stay (LOS) of 96 hours or less.
Discharge Planning
- Discharge planning is a coordinated, interprofessional process that develops a plan for continuing care after a patient leaves a health care agency.
- The focus of discharge planning is to ensure that a patient transitions to the setting in which health care needs can be appropriately met.
- Elements of discharge planning include:
- Determining the appropriate post-hospital destination for a patient
- Identifying a patient's needs for a smooth and safe transition
- Beginning the process of meeting a patient's needs while the patient is still hospitalized
- Discharge instructions prepare patients for transition from a hospital to the next level of care.
- Patients and family caregivers are involved in the decisions about the patient's discharge destination.
Restorative Care
- Restorative care helps patients regain maximal functional status and enhance quality of life through promotion of independence and self-care.
- Goals of restorative care include:
- Regaining functional status
- Enhancing quality of life
- Restorative care settings include:
- Home care
- Rehabilitation centers
- Skilled nursing facilities
- The restorative health care team is interprofessional and includes the patient and family or significant others.
Home Care
-
Home care is the provision of medically related professional and paraprofessional services and equipment to patients and families in their homes.
-
Services provided by home care include:
- Part-time, medically necessary skilled care (e.g., nursing, physical therapy, occupational therapy, and speech-language therapy)
- Coordination of access to and delivery of home health equipment
- Health maintenance, education, illness prevention, diagnosis, and treatment of disease, rehabilitation, and palliative care### Home Care Nursing
-
Home care nurses deliver highly individualized nursing care to patients with permanent or temporary physical limitations, enabling them to adapt to a daily home routine.
-
Home care requires a strong knowledge base in many areas, including family dynamics, cultural competence, spiritual values, and communication principles.
-
Nurses who work in Medicare-certified home care agencies conduct patient-specific comprehensive assessments at various points, including the start of care, 60-day follow-ups, discharge, and before and after an inpatient stay.
-
The comprehensive assessment, OASIS (Outcome and Assessment Information Set), includes standardized core assessment items for an adult home care patient.
OASIS Assessment
- OASIS forms the basis for measuring patient outcomes and improving home health care for the purposes of outcome-based quality.
- Data items within OASIS include sociodemographic information on the patient's home environment and informal caregivers, support system, health status, functional status, psychosocial status, and health service utilization.
Home Health Care
- Home health care focuses on the goal of helping patients and their family members achieve independence.
- Home care addresses the recovery from and stabilization of an illness, identifies problems related to lifestyle, safety, environment, family dynamics, and health care practices.
- Home care agencies provide skilled and intermittent professional services, such as wound care, administration of medications and blood therapy, and home care aide services.
Rehabilitation
- The World Health Organization (WHO) defines rehabilitation as the process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels.
- Rehabilitation gives people with disabilities the tools they need to attain independence and self-determination.
- Patients require rehabilitation after a physical or mental illness, surgery, injury, or chemical addiction.
- The goal of rehabilitation services is to help patients and families adjust to necessary changes in lifestyle and learn to function with the limitations of their disease.
Rehabilitation Services
- Rehabilitation services include physical, occupational, and speech therapy, and social services.
- Rehabilitation begins the moment a patient enters a health care setting for treatment, focusing on preventing complications related to an illness or injury, and then maximizing functioning and level of independence.
- Rehabilitation settings include rehabilitation units within acute care centers, freestanding outpatient settings, and the home.
Extended Care Facilities
- Extended care facilities provide intermediate medical, nursing, or custodial care for patients recovering from acute illness or those with chronic illnesses or disabilities.
- Extended care facilities include intermediate care and skilled nursing facilities, long-term care and assisted-living facilities.
- In the past, extended care facilities primarily cared for older adults, but now they provide care for patients of all ages due to the focus on early discharge from hospitals.
Nursing Centers or Facilities
- Nursing centers or facilities provide 24-hour intermediate and custodial care, including nursing, rehabilitation, dietary, recreational, social, and religious services for residents of any age with chronic or debilitating illnesses.
- Nursing center services provided by Medicaid-certified nursing homes offer skilled nursing, rehabilitation, and long-term care.
- Nursing centers must comply with the Omnibus Budget Reconciliation Act of 1987 and its minimum requirements for nursing facilities to receive payment from Medicare and Medicaid.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers the complexities and changes in the U.S. healthcare system, including efforts to reduce costs and improve access and quality. It also touches on the number of uninsured Americans and healthcare expenditures.