Chapter 6: Overview of Health Care Delivery

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 6: Overview of Health Care Delivery
MULTIPLE CHOICE
1. The gerontological nurse practitioner reports to a group of community planners that in

2003, approximately ____% of health care dollars spent were supported by
government funding.
a. 12
b. 45
c. 61
d. 85
ANS: b
In 2003, about 45% of health care dollars spent in the United States were funded by government
programs. Most were funded through Medicare.
DIF: Cognitive Level: Knowledge REF: Text Reference: 121

TOP: Nursing Process Step: N/A MSC: NCLEX: N/A
2. The nurse is accurate in depicting the health care system when noting that the primary
mechanism of the federal government to regulate hospitals at present is
a. compliance with Medicare regulations.
b. legislation of national standards.
c. regulation of malpractice.
d. mandates for patient safety.
ANS: a
As a major source of revenue, the federal government has been active in regulating the health
care industry. Most hospital beds are occupied by Medicare recipients. Therefore, hospitals have
a great incentive to comply with government guidelines.
DIF: Cognitive Level: Comprehension REF: Text Reference: 121

3. The acute care nurse recognizes that the organization representing most hospitals in
their efforts to influence legislation, regulations, and health care policy is the
a. American Hospital Association.
b. Healthcare Financing Administration.
c. Health Maintenance Organization.
d. American Medical Association.
ANS: a
Elsevier items and derived items Ó 2005 by Elsevier Inc.

Chapter 6: Overview of Health Care Delivery 2
Most hospitals are members of the American Hospital Association (AHA), which is their
representative in efforts to influence legislation, regulations, judicial decisions, and health care
policy.

4. A major reason for the increase in health care costs in the private sector is
a. more people seeking health care from specialists in acute care hospitals.
b. increased charges by hospitals to offset Medicare underpayments.
c. frequent refusal of clients to pay for the services provided.
d. decreased length of the hospital stay due to greater efficiency.
ANS: b
Increases in health care costs result from the health care industry’s practice of increasing charges
to offset underpayment by Medicare, Medicaid, and other contracted payers.

5. The nurse who is advancing a legislative agenda should be aware that the largest
group of health care providers in the United States is
a. nurses.
b. physicians.
c. pharmacists.
d. physical and occupational therapists.
ANS: a
Nurses outnumber every other group of health care providers.

6. The nurse who wants to refer to the 1991 document written by the American Nurses’
Association (ANA) in collaboration with other organized nursing groups to address
cost, quality, and access dilemmas would use
a. ANA Standards of Care.
b. Patient’s Bill of Rights.
c. Nursing’s Agenda for Health Care Reform.
d. advance directives.
ANS: c
In 1991, all organized nursing groups, led by the ANA, introduced Nusing’s Agenda for Health
Care Reform.


7. The nurse evaluating global U.S. social policy would recognize that the plan
established for financial stability for older adults is called
a. Social Security.
b. Medicare.
c. Medicaid.
d. Hill-Burton funds.
ANS: a
The Social Secuity Act of 1935 established as social policy the provision of financial stability for
the working class through a payroll tax.

8. The 1946 legislation that offered grants to build new hospitals and refurbish old
facilities and that required the recipients to pay back the grants dollar for dollar in
services for indigent clients was the
a. Community Health Plan.
b. Medicaid.
c. Hill-Burton Act.
d. War on Poverty.
ANS: c
The Hill-Burton Act was designed to create and update hospitals that would offer services to
indigent clients as “payback” for the grant.

9. The National Health Planning and Resources Act (Pulic Law 93-641) required
providers of new or expanded health services to make a formal request to a review
panel to grant a certificate of need in order to
a. establish mandatory health care programs.
b. eliminate duplicated services.
c. increase the supply of technological advances.
d. investigate the number of clients who might use the services.
ANS: b
The act was designed to “spread out” health care dollars and curb the oversupply and increasing
technology of facilities that arose during the period of expansion. The act was essentially a
failure.

10. In an effort to control the rising hospital costs in caring for Medicare recipients, the
Tax Equity and Fiscal Responsibility Act of 1982 mandated that
a. a prospective payment system be established.

b. hospitals standardize their charge for services.

c. physicians pay an equitable tax based on fees paid to them by Medicare.
d. hospitals pay a tax to be certified for reimbursment from Medicare.
ANS: a
The act temporarily limited Medicare payments until a prospective payment system (PPS) could
be designed. All hospitals serving Medicare clients were to switch to the diagnosis-related group
(DRG) system. The program became operational in 1983.

11. The nurse should plan programs based on the knowledge that changes in the
Medicare reimbursement system have resulted in
a. competition for non-Medicare patients.
b. longer hospital stays for clients with insurance.
c. more diagnostic studies for clients before surgery.
d. refusal of Medicare clients at many facilities.
ANS: a
Health care facilities compete for non-Medicare patients because the reimbursement is more
generous and more timely.
DIF: Cognitive Level: Comprehension REF: Text Reference: 128, 129;

12. The nurse who desires to participate in reform of the health care system should be
aware that many initiatives to improve U.S. health care are the result of
a. comparison to other countries.
b. a high standard of living.
c. professional integrity.
d. rising health care costs.
ANS: d
The health care system came under enormous pressure to curb costs and increase accessibility.

13. A client admitted to the hospital has “private pay” documented under the insurance
section of the admission form. The nurse understands that this client
a. has private, for-profit health insurance.
b. has private, not-for-profit health insurance.
c. has commercial insurance.
d. has no insurance and must pay the entire bill.
ANS: d
“Private pay” is a term used to describe clients who have no insurance.

DIF: Cognitive Level: Knowledge REF: Text Reference: 126, Box 6-1;
14. The nurse explains that the concept of capitation as a funding method means that
a. it is contracted most often for small groups.
b. the provider of care always makes a large profit.
c. payments are made to the provider only once a year.
d. payment involves a flat fee either per year or per incident of care.
ANS: d
Capitation is used when a large organization contracts for health services from a health care
provider. The provider is paid either a flat fee per incident of care or a flat fee by persons
enrolled in the health plan.
DIF: Cognitive Level: Comprehension REF: Text Reference: 126, Box 6-1;
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Health Promotion and Maintenance
15. The Balanced Budget Act of 1997 was a significant piece of legislation for the health
care industry because it
a. promised to lower health care costs by at least $1 billion in 20 years.
b. enabled states to convert to managed care without a federal Medicaid waiver.
c. allowed any health care agency to become a provider, ensuring all Americans
would have health care.
d. brought to a halt the trend for smaller hospitals and health care agencies to merge
into integrated delivery systems.
ANS: b
This act enabled states to convert to managed care without the need for a federal Medicare
waiver.

16. In the current managed care era, the percentage of beds occupied by Medicare
recipients is
a. 18%.
b. 26%.
c. 40%.
d. 52%.
ANS: c
Because Medicare is the major payer, hospitals are filled with Medicare recipients.


17. A health care program that the federal government funds in cooperation with the
individual states is
a. Medicare.
b. Medicaid.
c. Veterans Administration.
d. Retired military personnel.
ANS: b
The federal government health programs are Medicare, Medicaid, Veterans Administration (VA),
Department of Defense for military personnel, and workers’ compensation. The programs in
cooperation with the states are Medicaid and workers’ compensation.

18. The Ryan White bill (Public Law 101-381) provides funds for
a. inoculation of uninsured preschoolers.
b. mobile breast cancer screening programs.
c. prescription medication coverage for older adults.
d. AIDS education and related services and research.
ANS: d
The Ryan White bill funds education, research, and services related to acquired
immunodeficiency syndrome (AIDS).

19. The gerontological nurse practitioner finds it ironic that in all the millions of dollars
dedicated to health care expenditure, public health receives only
a. about 1%.
b. 3.5%.
c. 6.5%.
d. about 7%.
ANS: a
Only about 1% of money dedicated to health care goes to public health.

20. The health care industry has evolved through three different eras: period of
expansion, period of regulation and cost containment, and period of
a. reclassificaion.
b. revolt.
c. redirection.
d. reform.

ANS: d
The health care industry has evolved through periods of expansion, regulation and cost
containment, and reform.

21. The initiation of the Blue Cross system received support from
a. federal government agencies granting funds.
b. unions bargaining for fringe benefits.
c. politicians promoting the New Deal.
d. returning World War II veterans.
ANS: b
Unions bargained for health coverage as fringe benefits because money for pay increases was not
readily available. Also, middle-class workers were looking for health coverage.
DIF: Cognitive Level: Analysis REF: Text Reference: 125

22. The economic event that stimulated the expiration of the Hill-Burton Act was the
a. increase in availability of health insurance.
b. evolution of the Medicare and Medicaid programs.
c. increasing cost of health care nationwide.
d. overabundance of available hospital beds.
ANS: d
The Hill-Burton Act was designed to update existing hospitals and build new hospitals, which
would pay back the grant money by providing care to indigent clients. In the 1970s, oversuppply
of hospital beds caused the act to be redundant because there was no need for increased hospital
space.

23. A nurse for industry employees reassures a concerned group of workers about Part A
and Part B of Medicare. The nurse emphasizes that Part B
a. pays the cost of a hospital stay exceeding 3 days.
b. is provided through a payroll tax from all employed persons.
c. may be purchased by persons unqualified for Social Security benefits.
d. is an optional benefit of the Medicare Insurance Program.
ANS: d
Medicare Part B is an optional benefit that Social Security–qualified persons may purchase to
pay physician fees.


24. Concerned about his health care costs, a client asks the home health nurse about the
difference between an HMO and a PPO. The nurse explains that, although similar,
a(n)
a. HMO requires that members use only the facilities and services owned by the
HMO.
b. PPO is a free fringe benefit to employees of a facility that has contracted the PPO
services.
c. HMO requires that all members have a health assessment semi-annually.
d. PPO assigns each member or member family to a specific physician.
ANS: a
A health maintenance organization (HMO) is a closed service in which the members pay a
monthly premium and are assured of access to HMO-employed physicians in an HMO clinic or
hospital. In addition, members receive acute and preventive care. A preferred provider
organization (PPO) is a group of physicians and usually one hospital and other ancillary
providers who form a system that is marketed to employers.
DIF: Cognitive Level: Analysis REF: Text Reference: 126, Box 6-1;

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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 6: Overview of Health Care Delivery

1. The gerontological nurse practitioner reports to a group of community planners that in

DIF: Cognitive Level: Knowledge REF: Text Reference: 121

DIF: Cognitive Level: Comprehension REF: Text Reference: 121

Elsevier items and derived items Ó 2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 123

DIF: Cognitive Level: Comprehension REF: Text Reference: 124

DIF: Cognitive Level: Knowledge REF: Text Reference: 124

DIF: Cognitive Level: Knowledge REF: Text Reference: 125

Elsevier items and derived items Ó 2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 125

DIF: Cognitive Level: Knowledge REF: Text Reference: 125

DIF: Cognitive Level: Comprehension REF: Text Reference: 127

Elsevier items and derived items Ó 2005 by Elsevier Inc.

b. hospitals standardize their charge for services.

DIF: Cognitive Level: Comprehension REF: Text Reference: 128

DIF: Cognitive Level: Comprehension REF: Text Reference: 128, 129;

DIF: Cognitive Level: Knowledge REF: Text Reference: 123

Elsevier items and derived items Ó 2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 129

DIF: Cognitive Level: Knowledge REF: Text Reference: 121

Elsevier items and derived items Ó 2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 121

DIF: Cognitive Level: Knowledge REF: Text Reference: 124

DIF: Cognitive Level: Knowledge REF: Text Reference: 124

Elsevier items and derived items Ó 2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 129

DIF: Cognitive Level: Analysis REF: Text Reference: 125

DIF: Cognitive Level: Knowledge REF: Text Reference: 127

DIF: Cognitive Level: Knowledge REF: Text Reference: 127

Elsevier items and derived items Ó 2005 by Elsevier Inc.

MSC: NCLEX: Health Promotion and Maintenance

Elsevier items and derived items Ó 2005 by Elsevier Inc.

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