Chapter 03: The Changing U.S. Health and Public Health Care Systems
Stanhope: Foundations for Population Health in Community/Public Health Nursing,
5th Edition .
MULTIPLE CHOICE
1. A public health agency is planning to implement the electronic health record. Which of the
following is a benefit of this choice?
a. Facilitation of interprofessional care
b. Improved client compliance with medical regimens
c. Cost savings to the agency
d. Compliance with JCAHO standards
ANS: A
The electronic medical record facilitates interprofessional care in chronic disease management
and coordination of referrals; 24-hour availability of records with downloaded laboratory
results and up-to-date assessments; incorporation of protocol reminders for prevention,
screening, and management of chronic disease; improvement of quality measurement and
monitoring; increased client safety; and decline in medication errors. There is not evidence
that an electronic health record improves client compliance with medical regimens. Electronic
health records can increase costs to an agency. JCAHO does not accredit public health
agencies.
2. Which of the following best describes the cost of health care in the United States?
a. Health care costs are kept low, and the indicators of health are among the best
worldwide. N R I G B.C M
U ShasN resulted
b. Health care costs are low which T inOpoor health outcomes.
c. Health care costs are the highest in the world, but the indicators of health are not
the best worldwide.
d. Health care costs and indicators of health are the highest in the world.
ANS: C
Health care costs in the United States are the highest in the world and comprise the greatest
percentage of the gross domestic product, the indicators of what constitutes good health do not
document that Americans are really getting their money’s worth. Health care costs are not low
in comparison to the rest of the world. The health outcomes in the United States are poor in
comparison to other countries who spend less money on health care.
3. A nurse is explaining the health care system in the United States to a group of physicians
visiting from South America. How would the nurse best describe the current health care
system?
a. “It is a logical, rational approach to meeting expressed needs while still trying to
control costs.”
b. “It is a centralized system that provides care in hospitals.”
c. “It is divided primarily into two components: private health care and public health
care.”
d. “It is the best in the world with outstanding research and high-technology care
available to all.”
ANS: C
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, Foundations for Population Health in Community Public Health Nursing 5th Edition Stanhope Test Bank
Health care in the United States consists of a private or personal care system and a public
health system, with overlap between the two. The United States health care system is one of
the most expensive systems in the world that does not do a good job at controlling costs.
Care is provided through an enormous range of facilies and providers, including hosptials,
physicians’ and dentists’ offices, nursing homes, mental health facilities, ambulatory care
centers, and freestanding clincis. Although there is great research and high-technology care
in the United States, the health care outcomes of the country do not reflect this. Health care
disparities exist among multiple populations making this system not available to all.
4. Which of the following best describes ideal primary health care?
a. Based on a multidisciplinary group of health care providers that work as a team
b. Essential care available to all community members, which encourages
self-management
c. Focused on health promotion and disease prevention for everyone enrolled in the
health center
d. Local efforts to meet the Declaration of Alma Ata principles
ANS: B
Primary health care is generally defined as essential care made universally accessible to
individuals, families, and the community. Health care is made available to them with their full
participation and is provided at a cost that the community and country can afford. Public
health is described as organized and multidisciplinary efforts aimed at preventing disease and
promoting health, not primary care. Primary care provides for the integration of health
promotion, disease prevention, with curative and rehabilitative services. The Declaration of
Alma Ata was aimed at a world-wide, not local goal, to attain a level of health that permitted
all citizens of the world to live socially and economically productive lives.
N R I G B.C M
U toScontrol
N Tcosts of O care?
5. How does managed care attempt
a. By encouraging families to use the point of service list of individual practice
associates
b. By requiring families to choose a care provider from the MC network and not
allowing access to other services without their provider’s permission
c. By moving Medicaid-eligible families onto state Medicare enrollment
d. By refusing permission for families to use urgent care or emergency department
services
ANS: B
Managed care is a system in which care is delivered by a specific network of providers. Each
provider serves as a gatekeeper who controls access to other providers and services. Cost is
reduced because members cannot use specialists or seek hospital or other care without
permission from their primary-care providers. Thus, those enrolled in Medicaid managed care
have restrictions that help keep costs down for government (and for taxpayers). Managed care
provides care through a specific network of providers who agree to comply with the care
approaches established through a case management approcah, not through a point of service
list of individual practice associates. Medicaid and Medicare programs are not
interchangeable, these programs serve different populations. Managed care does not refuse
permission for certain services such as urgent care or emergency department, rather a case
management approach is used to control costs.
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