ATI RN
Economic Foundation of the US Healthcare Delivery System Questions
Question 1 of 5
Which best describes a current trend related to health care services?
Correct Answer: B
Rationale: There is a national shift from nonprofit health care to for-profit health care as large for-profit organizations take over smaller community organizations. Because emphasis is on profit, mechanisms of achieving higher reimbursement have been developed. Coding of the patient's illness from the CPT codes determines reimbursement. Use of computerized medical record programs almost ensures that service can be reimbursed at the highest rate possible. This has changed health care practices to the use of services that are low in cost and higher in reimbursement. High-cost services are limited or not offered.
Question 2 of 5
Which best describes what happens when a health care organization receives federal funding for a special health care need?
Correct Answer: D
Rationale: When the funding is no longer provided, the programs cease, which results in lack of continuity of care. Research may be done related to the program, other programs may be developed because of the current program that is being implemented, and participants may encourage local funding to continue. However, the most likely outcome is that the program will end when the funding ends, so there is no continuity in the services that are provided.
Question 3 of 5
Which best describes what was done by large industrial giants to stop the constant increase in their costs for health insurance for their employees?
Correct Answer: A
Rationale: Large industrial giants, such as Kaiser Permanente, decided to assemble their own health care programs. They built hospitals, hired physicians, and provided health care services to their employees. In an effort to market this concept, the phrase health maintenance organization was created. These organizations were designed to provide comprehensive care to employees. As these large health care programs were established, enrollees had limited freedom of choice. Preventive care was covered and encouraged, but care was somewhat restricted, and care providers were encouraged to reduce costs by providing only the most necessary services.
Question 4 of 5
Which best describes how the government was successful at containing costs?
Correct Answer: D
Rationale: Prospective payment based on DRGs proved to be effective. The cost reduction that resulted gave rise to the managed care revolution as providers searched for the most cost-effective mechanism of care provision. Various efforts from, for example, certificate-of-need, peer review, and utilization review were not effective.
Question 5 of 5
Which statement best summarizes all of the changes resulting from attempts to control costs?
Correct Answer: A
Rationale: All these changes resulted in conflicts among providers, patients, employers, and the insurance plans, particularly when services deemed necessary by the consumer and provider were denied insurance coverage. Everyone blamed everyone else. This did not allow for costs to be controlled, impact the demand for health care, or cause employers to discontinue their insurance plans for employees.