Chapter 23 Economic and Legal Issues

Chapter 23  Economic and Legal Issues

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. Which of the following statements is true about health care costs for older adults in the United States?
a.
Older adults become eligible for full Social Security benefits upon reaching the age of 65 years.
b.
Medicare, Part A, covers physician visits, whereas Part B covers prescription drugs.
c.
Health maintenance organizations (HMOs) can obtain an exemption from Medicare’s per capita spending limit.
d.
Older adults pay a fixed premium and low out-of-pocket costs in a preferred provider organization (PPO).

ANS: C
If an HMO is granted a per capita waiver, it cannot refuse an applicant on the basis of a preexisting condition. The eligibility age for full Social Security benefits is 66 years of age for persons born after 1937 and 67 years of age for those born in 1960 or later. Medicare, Part A, covers hospitalizations and other inpatient care. Medicare, Part B, which is optional insurance purchased by the beneficiary, covers outpatient services, physician visits, some therapy sessions, and some home health care. Older adults that pay a fixed premium and low out-of-pocket costs is a description of an HMO rather than a PPO.

PTS: 1 DIF: Remember REF: 10-11
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

2. Managed care systems are most effective for an older adult who does which of the following?
a.
Avoids using the system until it is really needed in an emergency.
b.
Avoids seeing generalists and seeks health care only from specialists.
c.
Uses high-tech treatments to reduce expenses over the long term.
d.
Seeks regular primary care and preventive strategies to maintain health.

ANS: D
Managed care is most effective for individuals who, over a long period of enrollment, use primary care and preventive behavior to avoid the need for intensive treatment.
Avoiding using the system until it is needed in an emergency is both costly and detrimental to the client’s health. Managed care systems limit access to specialists and encourage the use of primary care. Managed care systems favor ongoing subacute care and prevention to avoid the need for high-tech, acute treatments.

PTS: 1 DIF: Understand REF: 10-11
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

3. When an older adult is considering long-term care insurance (LTCI), which is an important consideration?
a.
Carefully scrutinize all exclusions before enrolling.
b.
Apply at the oldest age possible for lower rates.
c.
Avoid purchasing LTCI through a group policy.
d.
Delay application until the government sponsors LTCI.

ANS: A
As with everything else in life, always read the fine print. For example, many plans strictly limit benefits for those with Alzheimer disease. The rates may go up with age at application. The best LTCI packages have been obtained by large organizations with considerable negotiating power. LTCI plans do not receive any government support; therefore the subscriber finances his or her own LTCI.

PTS: 1 DIF: Understand REF: 15
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

4. Which of the following statements is true about case management and care management for older adults?
a.
A case manager works for a health care system to save time and money.
b.
Care managers are usually paid from public agencies such as the Area Agency on Aging (AAA).
c.
One nurse can only perform care management.
d.
The Outcomes-Based Quality Improvement system is designed to evaluate the expected benefit of a procedure.

ANS: A
A case manager works for a health care system to save time and money. Care managers are rarely paid through the AAA or similar agencies; they are usually paid privately and sometimes through Medicare or Medicaid. The nurse can perform case management and care management. The aspects measured in an Outcomes Based Quality Improvement System are known as efficacy, effectiveness, and efficiency.

PTS: 1 DIF: Understand REF: 16
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment