Chapter 11: The Health Care System

Test Bank

MULTIPLE CHOICE

1.Which of the following best describes the principal factor behind ongoing legislation on the federal level related to health care?

a. Change is needed to reflect differences in health needs today.

b. Efforts must be put in place to control constantly increasing costs.

c. There is a need to focus on the population as a whole.

d. Technological breakthroughs should be expanded.

ANS: B

With the rapid growth of technology and increased demands on the private and public health care subsystems, health care costs have become prohibitive. Cost-effectiveness and cost containment have become critical driving forces as health care delivery system changes are made; however, cost-effectiveness often conflicts with the provision of quality care. The Institute of Medicine (IOM) report Best Care at Lower Costs: The Path to Continuously Learning Health Care in America “presents a vision of what is possible if the nation applies the resources and tools at hand by marshaling science, information technology, incentives, and care culture to transform the effectiveness and efficiency of care—to produce high-quality health care that continuously learns to be better” (2012, p. ix). Since 1999, the IOM has completed many extensive reports examining the status of health care in the United States. Some improvement has been seen in the delivery system, but much more needs to be done. This report addresses these critical concerns again.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 187

2.Which of the following best describes the most common organization for receiving personal health care in the United States today?

a. A group of physicians all in a particular specialty group who share an office

b. Community health center that includes educational and social services

c. Fee for service by a physician in practice by himself or herself

d. Managed care organization with capitated payments to providers, both professionals and organizations

ANS: D

Managed care has become the dominant paradigm in health care. This model has replaced fee for service by a physician in independent practice or physicians in a group practice, and care in a community health center.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 187

3.Which of the following best describes how voluntary health agencies fit into the overall health care system?

a. They fill in the gaps between services offered by private and public health systems.

b. They primarily serve as sources of financial aid for the underserved.

c. They supplement the effort of the public health care system.

d. They support research, education, and services for particular groups of patients.

ANS: D

Voluntary health agencies are committed to specific diseases, organ or body structures, health and welfare of special groups, or particular phases of health. Philanthropic groups support research and programs. These organizations provide major sources of help in preventing disease, promoting health, treating illness, consumer education, and advocacy and research. Unfortunately, there continue to be overlaps among private, voluntary, and public agencies, but without voluntary agencies, fewer services would be available.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 188

4.Which of the following levels of government primarily establishes regulations and provides funding for health care?

a. Federal government

b. Local health departments

c. Regional health districts

d. State health departments

ANS: A

The federal government has been assuming a larger role in the protection of the population through regulation and funding. Local health departments establish local health codes, fund public hospitals, and provide services to populations at risk who often lack health insurance. State health departments are highly dependent on the federal level of resources and guidance. Regional health districts are not used as a level of government in the United States.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 192

5.Which of the following federal agencies is responsible for administering most of the federal health-related activities?

a. Centers for Disease Control and Prevention (CDC)

b. Department of Health and Human Services (DHHS)

c. Health Resources and Services Administration (HRSA)

d. National Institutes of Health (NIH)

ANS: B

Most health-related activities at the federal level are implemented and administered by the DHHS. The responsibility of the CDC is to keep the public safe and healthy. The responsibility of the HRSA is to improve access to health care services for vulnerable groups in the population. The main responsibility of the NIH is biomedical and health-related research.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 189

6.Which of the following federal agencies is responsible for the Women, Infants, and Children (WIC) program, food stamps, and school-based nutrition programs?

a. Aid to Dependent Children Department

b. Department of Agriculture

c. Department of Education

d. Department of Health and Human Services

ANS: B

The Department of Agriculture administers the inspection of meat and milk, and provides funds for the WIC program (supplemental nutrition), the food stamp program, and the school-based nutrition program. The Aid to Dependent Children is a program, not a department, that provided financial assistance to families with limited financial resources. The Department of Education administers and coordinates resources related to education. The Department of Health and Human Services is responsible for protecting the health of all Americans.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 189

7.Which of the following best describes the approach to health care used by states?

a. Federal funding encourages experimentation in creating new programs.

b. Insurance regulations concerning reimbursement cross state lines.

c. Information about successful programs is known to legislators.

d. States frequently develop new programs as federal funds become available to pay for them.

ANS: D

Many state and local government programs were developed on the basis of availability of federal funds. Funds are accompanied by regulations, which apply to all recipients. These have served to standardize health policy. Federal funding is limited, thus there is limited opportunity for experimentation. Legislators must be involved in ongoing education in order to keep up to date on what is happening with programs that have been implemented. Insurance regulations are monitored by individual states so reimbursement concerns are unable to cross state lines.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 191

8.Which of the following has led to the more recent focus on cooperation between the state and the federal level in relation to public health?

a. The emphasis of Healthy People 2020

b. The ongoing continued restriction of financial resources

c. The new presidential administration’s goals

d. The threat of bioterrorism

ANS: D

Cooperation between the state and federal levels has been brought to the forefront with efforts to plan for bioterrorism, an event that would necessitate cooperation and sharing. In addition, the state is highly dependent on the federal level for resources and guidance. The administrative goals of the president, emphasis of Healthy People 2020, and restriction of available financial resources have not been the main factor that has led to an increase in cooperation related to public health.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 191

9.Which health care provider organization is seeing an increase in the demand for their services?

a. Physician practice

b. Hospice service

c. Hospitals

d. Long-term care facilities

ANS: D

Hospital stays have shortened and patients who are admitted are more acutely ill and require more intensive care. Consequently, decreased hospital stays result in more home care admissions and more discharges to long-term care facilities for short-term recovery and rehabilitation. Hospice services and physician practices have not been as impacted as greatly by this shift in where care is provided.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 192

10.Which of the following advanced nurses does not have advanced education in a clinical specialty?

a. Clinical nurse leader

b. Clinical nurse specialist

c. Nurse midwife

d. Nurse practitioner

ANS: A

All the nurses have advanced education in some aspect of clinical care, such as obstetrics or primary care. However, the clinical nurse leader is a manager of care at some point of care and does not have a clinical specialty.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 193