ATI RN
Future Economic Needs of the US Healthcare System Questions
Question 1 of 5
Which best describes what physicians did to compete with new competition from health maintenance organizations (HMOs)?
Correct Answer: B
Rationale: In an effort to compete with HMOs, physicians and hospitals organized the independent practice model, which provided services to enrollees of one insurance company. This model evolved into the PPO, which offered services at a reduced rate in exchange for a guaranteed increase in consumers. Physicians did not become directly employed by insurance companies, set up private practices with colleagues, or decide to strike in order to compete with the HMOs.
Question 2 of 5
Which best describes how providers can legally improve their profit under the current reimbursement process?
Correct Answer: D
Rationale: As a reward for conservative medical practices, health care providers may receive a specified amount of money or a percentage of the agreed reimbursement if services are delivered below the limit set by the third-party payer. Thus, it is the responsibility of the provider to use this conservative practice. Patient care should not be compromised as providers practice conservatively.
Question 3 of 5
When was the idea of national health care insurance first debated in the United States?
Correct Answer: D
Rationale: European countries began a social model of health insurance in the early 1900s. President Theodore Roosevelt advocated a similar plan for the United States in 1916. The other attempts mentioned came after Theodore Roosevelt's initial attempt in 1916.
Question 4 of 5
Which best describes a carve-out service?
Correct Answer: A
Rationale: Carve-out services might be designated for those who need the services the least. A carve-out service (e.g., mental health care) is provided within a standard benefit package but delivered exclusively by a designated provider or group. The other definitions do not correctly describe a carve-out service.
Question 5 of 5
Which best describes the effects of Medicare and Medicaid? (Select one that does not apply)
Correct Answer: A
Rationale: The enactment of Medicare and Medicaid created an unprecedented demand for services, and many persons without access to health care were now able to receive care using an indemnity insurance plan. Medicare reimbursement rates generally became the standard for all insurance carriers. These plans did not provide services for the temporarily disabled or change financing for public health education.