NUR3678 Test 3 Community Blueprint Questions With
Complete Solutions
What does payment look like for Medicare Part A?
- deductible must be paid; covers up to 60 days in an inpatient
hospital
- does not pay for all health care costs of enrollees
- an additional copay must me paid for days 61-90 and the copay
increases with each day
What is Medicare Part B? What does it cover?
- can be purchased monthly by people with Medicare Part A
- pays for out-of-pocket costs related to physician visits, hospital
outpatient care, medical equipment, etc.
- premiums prorated based on income
- enrollees must pay deductibles and coinsurance
What is Medicare Part C? What does it cover?
- aka Medicare Advantage Plans
- optional "gap" covered by private insurance companies
- covers health maintenance organizations (HMOs) and
preferred provider organizations (PPOs)
What are health maintenance organizations (HMOs) and
preferred provider organizations (PPOs)? What are the
requirements to be eligible for these plans?
- health care plans covered under Medicare Part C
- services vary by plan, but include vision, hearing, and dental
,care and other services not covered by Medicare Parts A,B,C,
and D
- individuals must have Medicare Parts A and B and live in
service area to be eligible
What is Medicare Part D? What does it cover?
- covers prescription drugs
- when the enrollee's out-of-pocket total for drugs reaches a
particular level, Medicare will pay for 95% of the costs for any
further prescription drugs
What is Medicaid? Who is covered by Medicaid? How is one
eligible for this program?
- a public welfare assistance program
- Provides universal health care coverage for the indigent,
children, women, the disabled, and impoverished elders and
adults below poverty line in some states
- Eligibility for this program depends on the size and income of
the family.
- federal government sets baseline services, but state
governments may provide more services.
What types of services does Medicaid include?
inpatient and outpatient hospital care, pregnancy-related care,
Vaccines For Children, family planning services, rural health
clinics, home health care, laboratory and x-ray services, EPSDT,
pediatric and family nurse practitioners
Health Maintenance Organization (HMO)
,- More comprehensive care
- Lacked enrollees freedom of choice
- Preventative care covered
- Specialty care restricted
- Encouraged to reduce costs by only providing most necessary
services
Preferred Provider Organization (PPO):
- Negotiated with health care providers for services at reduced
rate in exchange for guaranteed increase in consumers
- Negotiated reimbursement rate allows cost of plan to be
somewhat controlled.
- Enrollees offered incentives for choosing health care from
within the plan's network.
- More flexible than HMOs
What is cultural competence?
respecting and understanding the values and beliefs of a certain
cultural group so that one can function effectively in caring for
members of that cultural group.
Culturally competent community health nursing requires that the
nurse understand what about diverse individuals, families,
groups, and communities (3)?
- Lifestyle
- Value system
- Health and illness behaviors
What population trends are we seeing in the United States?
, Increase in minority groups:
- In 1970, minority groups were 16% of population.
- By 2017, minority groups increased to 38.7% of population.
- By 2060, minorities will account for more than 56% of total
population.
Naturalistic perspective
yin yang is Chinese philosophy that looks at energy forces.
balance between opposing forces to help maintain.
yin is female and negative force - emptiness, dark, cold
yang - male and positive and light and warm
if u have an illness, from this perspective, you have an illness
caused by yin yang and they are going to make sure u have a
balance of those forces. imbalance of too much hot or too much
cold. eating different foods considered warm and cold. Cold
foods are eaten when the person has a hot illness such as fever,
rash, sore throat, ulcer, infection. Hot foods are eaten when
someone has a cold illness such as cancer, headache, stomach
cramps, colds. BALANCE AND ACCOMMODATE THE
INDIVIDUAL
Magico-Religious Perspective
supernatural forces
impact on illness
voodoo, witchcraft, prayer, religious rituals, evil eye as a form
of protection
Biomedical perspective:
Complete Solutions
What does payment look like for Medicare Part A?
- deductible must be paid; covers up to 60 days in an inpatient
hospital
- does not pay for all health care costs of enrollees
- an additional copay must me paid for days 61-90 and the copay
increases with each day
What is Medicare Part B? What does it cover?
- can be purchased monthly by people with Medicare Part A
- pays for out-of-pocket costs related to physician visits, hospital
outpatient care, medical equipment, etc.
- premiums prorated based on income
- enrollees must pay deductibles and coinsurance
What is Medicare Part C? What does it cover?
- aka Medicare Advantage Plans
- optional "gap" covered by private insurance companies
- covers health maintenance organizations (HMOs) and
preferred provider organizations (PPOs)
What are health maintenance organizations (HMOs) and
preferred provider organizations (PPOs)? What are the
requirements to be eligible for these plans?
- health care plans covered under Medicare Part C
- services vary by plan, but include vision, hearing, and dental
,care and other services not covered by Medicare Parts A,B,C,
and D
- individuals must have Medicare Parts A and B and live in
service area to be eligible
What is Medicare Part D? What does it cover?
- covers prescription drugs
- when the enrollee's out-of-pocket total for drugs reaches a
particular level, Medicare will pay for 95% of the costs for any
further prescription drugs
What is Medicaid? Who is covered by Medicaid? How is one
eligible for this program?
- a public welfare assistance program
- Provides universal health care coverage for the indigent,
children, women, the disabled, and impoverished elders and
adults below poverty line in some states
- Eligibility for this program depends on the size and income of
the family.
- federal government sets baseline services, but state
governments may provide more services.
What types of services does Medicaid include?
inpatient and outpatient hospital care, pregnancy-related care,
Vaccines For Children, family planning services, rural health
clinics, home health care, laboratory and x-ray services, EPSDT,
pediatric and family nurse practitioners
Health Maintenance Organization (HMO)
,- More comprehensive care
- Lacked enrollees freedom of choice
- Preventative care covered
- Specialty care restricted
- Encouraged to reduce costs by only providing most necessary
services
Preferred Provider Organization (PPO):
- Negotiated with health care providers for services at reduced
rate in exchange for guaranteed increase in consumers
- Negotiated reimbursement rate allows cost of plan to be
somewhat controlled.
- Enrollees offered incentives for choosing health care from
within the plan's network.
- More flexible than HMOs
What is cultural competence?
respecting and understanding the values and beliefs of a certain
cultural group so that one can function effectively in caring for
members of that cultural group.
Culturally competent community health nursing requires that the
nurse understand what about diverse individuals, families,
groups, and communities (3)?
- Lifestyle
- Value system
- Health and illness behaviors
What population trends are we seeing in the United States?
, Increase in minority groups:
- In 1970, minority groups were 16% of population.
- By 2017, minority groups increased to 38.7% of population.
- By 2060, minorities will account for more than 56% of total
population.
Naturalistic perspective
yin yang is Chinese philosophy that looks at energy forces.
balance between opposing forces to help maintain.
yin is female and negative force - emptiness, dark, cold
yang - male and positive and light and warm
if u have an illness, from this perspective, you have an illness
caused by yin yang and they are going to make sure u have a
balance of those forces. imbalance of too much hot or too much
cold. eating different foods considered warm and cold. Cold
foods are eaten when the person has a hot illness such as fever,
rash, sore throat, ulcer, infection. Hot foods are eaten when
someone has a cold illness such as cancer, headache, stomach
cramps, colds. BALANCE AND ACCOMMODATE THE
INDIVIDUAL
Magico-Religious Perspective
supernatural forces
impact on illness
voodoo, witchcraft, prayer, religious rituals, evil eye as a form
of protection
Biomedical perspective:
