Chapter 16: The Health Care System: Financing, Issues, and Trends Knecht: Success in Practical/Vocational Nursing, 8th Edition

1. When the nurse is asked by a patient, “Why is it necessary to have deductibles and copayments when I already have health insurance?” The best response would be: a. “They are a way to improve the margin of profit in the fee-for-service method of paying for health care.” b. “They prevent health care agencies from having huge deficits associated with uncompensated care.” c. “They were developed to save health care dollars at the time Medicare introduced DRGs.” d. “They are part of the incremental changes designed to provide more universal care.” ANS: A Deductibles and copayments require the patient to pay an increased share of the cost of treatment, thus improving the profit margin for the insurer. They benefit the insurer more than the agency. Deductibles and copayments were not developed to save health care dollars at the time Medicare introduced DRGs. Deductibles and copayments are not part of the incremental changes designed to provide more universal care. DIF: Cognitive Level: Application REF: p. 223 OBJ: 2 TOP: Deductibles and copayments KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment 2. A patient tells the nurse, “I didn’t sign up for health care insurance at my job because I’m young and healthy and can use the money in other ways.” The response that best explains the advantage of health insurance would be a. “With insurance a fiscal middleman pays your health care bills.” b. “With insurance your individual contributions go directly to paying your personal expenses.” c. “With insurance you can borrow money for unexpected health care expenses at a very low interest rate.” d. “With insurance you are spreading the risk in case you have a serious health event, such as cancer or major trauma.” ANS: D Health insurance, like any insurance, spreads risk. The risk that is spread in health insurance is that the young and the healthy generally subsidize (support financially) the sick and older persons in the health insurance group. Individual contributions are pooled for the protection of individuals from financial disaster due to health care bills. A fiscal middleman does pay health care bills, but this does not address the best explanation of the advantage of health insurance. The remaining options are not factual statements. DIF: Cognitive Level: Analysis REF: p. 223 OBJ: 2 TOP: Advantage of health insurance KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment [Show less]