ATI RN
Economic Foundation of the US Healthcare Delivery System Questions
Question 1 of 5
Which best describes why large employers would decide to self-insure?
Correct Answer: D
Rationale: Some organizations have decided to self-insure their employees. This reduces the administrative cost of insurance. Self-insurance does not claim to offer more benefits to employees, allow for more control over health care providers, or do a better job at keeping employees happy.
Question 2 of 5
Which statements best describe what was unfortunate about the original private health insurance plans that were developed? (Select one that does not apply.)
Correct Answer: D
Rationale: The majority of the population was protected. The emphasis was placed on illness care, because providers received a fee only when a service was rendered, and all costs were reimbursed. Insulated from having to pay for health care, consumers demanded complex and technologically advanced services. These demands were a major force rapidly increasing health care costs because people with insurance felt entitled to care, and, after all, there was a guaranteed payer. Medical orientation was on curing at any cost. The profits of owning or managing an insurance company were not immediately seen.
Question 3 of 5
Which best describes what insurance companies did to decrease their constantly increasing costs? (Select one that does not apply)
Correct Answer: D
Rationale: Insurance companies attempted to reduce unnecessary use by limiting coverage for certain services and people. Restrictions such as the establishment of a gatekeeper that required preauthorization, limited coverage for preexisting illnesses, and exclusion of participants whose use was deemed exorbitant were instituted. Such restrictions increased resentment and resistance and were not very successful.
Question 4 of 5
Who may receive benefits under Medicare? (Select one that does not apply.)
Correct Answer: B
Rationale: Medicare pays specified health care services for all people 65 years of age and older who are eligible to receive Social Security benefits. People with permanent disabilities and those with end-stage renal disease are also covered.
Question 5 of 5
Which statements best describe an unfortunate consequence of using diagnosis-related groups (DRGs) to determine reimbursement? (Select all that apply.)
Correct Answer: B
Rationale: Because costs were contained by both the federal programs and insurance companies, the providers had a strong incentive to undertreat and underuse health resources. The public feared that the quality of care being provided was less to keep costs as low as possible.