Chapter 03 Health Policy and the Delivery System

Chapter 03  Health Policy and the Delivery System

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE
1. The most autonomous form of insurance for the provider and the client perspective is:
a.
A fee-for-service plan
b.
A health maintenance organization (HMO)
c.
A preferred provider organization (PPO)
d.
An independent practice association (IPA)

ANS: A
In the fee-for-service plan, a provider provides a service and bills the individual’s insurance company. The individual is also allowed to choose his or her provider.

DIF: Cognitive Level: Application REF: 66-67

2. Which form of managed care restricts providers to caring for clients who are members of their organization?
a.
A fee-for-service plan
b.
A health maintenance organization (HMO)
c.
A preferred provider organization (PPO)
d.
An independent practice association (IPA)

ANS: B
The traditional HMO was a group or staff model where a group of physicians and some specialty services provided care to its members. Providers generally spent all their time serving members of the HMO. Fee-for-service, IPAs, and PPOs are not restricted to serving clients for any one organization.

DIF: Cognitive Level: Knowledge REF: 67

3. A family of six includes two working parents. Neither employer provides health insurance for this family. The family does not meet the financial criteria for Medicaid. However, they may be eligible for which of the following federal programs?
a.
Medicare
b.
Civilian Health Medical Program for Uniformed Services (CHAMPUS)
c.
State Children’s Health Insurance Program (SCHIP)
d.
Veteran’s Administration Program

ANS: C
The State Children’s Health Insurance Program is a public state insurance program established to provide insurance to uninsured children whose family is typically described as the working poor and don’t meet Medicaid requirements. In this case, both parents work but do not have access to insurance through their employers. Additionally, they do not meet the financial Medicaid requirement.

DIF: Cognitive Level: Application REF: 70

4. A nurse complies with the Patient Self-Determination Act when:
a.
She asks a client upon admission to the hospital if he has an advanced directive
b.
She asks a client in the recovery room if he has an advanced directive
c.
She asks a client before discharge from the hospital if he has an advance directive
d.
She asks the family about an advanced directive after the client has been intubated

ANS: A
The Patient Self-Determination Act is designed to increase individual involvement in decisions about life-sustaining treatments. The nurse must ensure that advanced directives are available to physicians at the time the medical decision is being made. Therefore, the nurse complies with the act when she asks a client upon admission to the hospital if he or she has an advanced directive.

DIF: Cognitive Level: Application REF: 73

5. A nurse discussing the case of Mrs. Jones, a 60-year-old on the surgical unit s/p gastric bypass surgery, with her cardiologist husband is in violation of:
a.
The Patient Self-Determination Act
b.
The Health Insurance Portability and Accountability Act of 1996
c.
The American’s Disabilities Act
d.
The Civil Rights Act

ANS: B
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal privacy standard that requires safeguards to protect the security and confidentiality of health information. Disclosures without individual authorization are allowed only to public health authorities authorized by law to collect and receive information for the purpose of preventing or controlling disease, injury, or disability.

DIF: Cognitive Level: Application REF: 73