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. Prospective payment system
b. Retrospective payment system
c. Single-payer system
d. Capitation
A client who is reading a newspaper asks, This article about health care states that many providers of health care lack effectiveness. What is the difference between effectiveness and efficiency? The nurse explains that:
a. effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome.
b. effective refers to competence in clinical practice and efficiency describes quick completion of the task.
c. efficiency means wasting and meeting a minimum standard and effectiveness refers to taking all the time needed to exceed expectations.
d. efficiency refers to speed and effectiveness refers to the usefulness of the implementation.
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. is more likely to participate in mammography screening than are individuals covered by private insurance.
b. has designated primary care and a specialist as sources of care.
c. will more likely wait to seek care and will require hospitalization for a mastectomy, which could have been avoided if care had been sought earlier.
d. has decreased access to health care when compared with the uninsured.
A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting.
The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis:
a. the cost of caring for this client was 5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company.
b. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee.
c. the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease.
d. the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.
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