NUR 4837 Complete Solution guide (2023/2024) 100% verified
Including general internists and general pediatricians, what does the total supply of generalist
amount to in the United States? How does this number compare with the UK? - (correct answer)the
total supply of generalists (including internists and pediatricians) amounts to 1/3 (33%) of all
physicians in the US. In the UK it is about 50%.
What is one action taken to fill the primary care gap in the United States? - (correct answer)Some
physicians at the secondary and tertiary care levels have also acted as PCPs for their patients.
Who is more likely to work in primary care settings than physicians? - (correct answer)Nurse
practitioners and physicians assistants
Who is the Care Coordinator and "Gatekeeper"? - (correct answer)- The primary care provider is the
gatekeeper
Example: Polly sees a nurse practitioner who discovers that the reason she is vomiting is due to the
medication she is taking. The NP consults with the oncologist to change her medication/prescription
Stories such as Polly's demonstrate the importance of having a generalist care coordinator who can
advocate on behalf of his or her patients and work in partnership with patients to integrate an array
of services involving multiple providers to avoid duplication of services, enhance patient safety, and
care for the whole person.
What are the forces driving healthcare in the U.S.? - (correct answer)- Biomedical model among
medical educators
- Financial incentive for physician specialization and hospital expansion
- Professionalism- acting in patient's best interest
Who benefits from Medicare? - (correct answer)Medicare is for the elderly
Part A of Medicare - (correct answer)Hospital insurance plan for the elderly financed largely through
social security taxes from employers and employees
Part B of Medicare - (correct answer)Insures the elderly for physician services and is paid for by
federal taxes and monthly premiums from the beneficiaries
Part D of Medicare - (correct answer)Offers prescription drug coverage and is paid for by federal
taxes and monthly premiums from beneficiaries.
Enacted in 2003
Medicaid - (correct answer)A program run by the states and is funded by federal and state taxes,
which pays for the care of millions of LOW-INCOME PEOPLE
Medicare Modernization Act of 2003 - (correct answer)provided:
- the expansion of the role of private health plans (the Medicare Advantage program, Part C)
-establishment of a prescription drug benefit (Part D)
What are the first generation health maintenance organizations? - (correct answer)-Kaiser
, NUR 4837 Complete Solution guide (2023/2024) 100% verified
-HMOs (health maintenance organizations)
Both are prepaid group practices
What are the second generation health maintenance organizations? - (correct answer)-Independent
Practice Association or IPAs (or network HMOs, integrated medical groups, Physician- Hospital
Organizations (PHO))
-Health Maintenance Organization Act of 1973 based on second generation of network HMOs that
evolved from Kaiser- Permanente Medical Care program
What is a Preferred Provider Organizations (PPO)? - (correct answer)allow patients to choose their
own providers outside of a traditional HMO model
there may be increased costs to the patient in this type of model compared with HMO models
What did the Affordable Care Act of 2010 do? - (correct answer)-expansion of health insurance
-reform in how health care is organized and delivered through the concept of the Accountable Care
Organization
What is an Accountable Care Organization (ACO)? - (correct answer)A provider-led organization
whose mission is to manage the full continuum of care and can be accountable for the overall costs
and quality of care for a defined population
Many ACOs contract with both Medicare and private plans. (private health insurers changing PPO
into ACO models emulating the Medicare Shared Savings Program
What did the Affordable Care Act of 2012 authorize? - (correct answer)-authorized Medicare to
initiate an ACO program beginning in 2012
What are the 4 modes of paying for care? - (correct answer)-out of pocket
-private insurance
-employment based
-government based
What are the 3 forms of Managed Care? - (correct answer)-Fee for service practice with utilization
review
-PPO
-HMO
Fee- for- Service Payment with Utilization Review - (correct answer)This is the traditional type of
payment, with the addition that the third-party payer, whether private insurance company or
government agency, assumes the power to authorize or deny payment for expensive medical
interventions such as hospital admissions, extra hospital days, and surgeries.
Preferred Provider Organization (PPO) - (correct answer)-Patients are able to see physicians not
included within their insurer's physician network if they desire, but have to pay a higher share of
Including general internists and general pediatricians, what does the total supply of generalist
amount to in the United States? How does this number compare with the UK? - (correct answer)the
total supply of generalists (including internists and pediatricians) amounts to 1/3 (33%) of all
physicians in the US. In the UK it is about 50%.
What is one action taken to fill the primary care gap in the United States? - (correct answer)Some
physicians at the secondary and tertiary care levels have also acted as PCPs for their patients.
Who is more likely to work in primary care settings than physicians? - (correct answer)Nurse
practitioners and physicians assistants
Who is the Care Coordinator and "Gatekeeper"? - (correct answer)- The primary care provider is the
gatekeeper
Example: Polly sees a nurse practitioner who discovers that the reason she is vomiting is due to the
medication she is taking. The NP consults with the oncologist to change her medication/prescription
Stories such as Polly's demonstrate the importance of having a generalist care coordinator who can
advocate on behalf of his or her patients and work in partnership with patients to integrate an array
of services involving multiple providers to avoid duplication of services, enhance patient safety, and
care for the whole person.
What are the forces driving healthcare in the U.S.? - (correct answer)- Biomedical model among
medical educators
- Financial incentive for physician specialization and hospital expansion
- Professionalism- acting in patient's best interest
Who benefits from Medicare? - (correct answer)Medicare is for the elderly
Part A of Medicare - (correct answer)Hospital insurance plan for the elderly financed largely through
social security taxes from employers and employees
Part B of Medicare - (correct answer)Insures the elderly for physician services and is paid for by
federal taxes and monthly premiums from the beneficiaries
Part D of Medicare - (correct answer)Offers prescription drug coverage and is paid for by federal
taxes and monthly premiums from beneficiaries.
Enacted in 2003
Medicaid - (correct answer)A program run by the states and is funded by federal and state taxes,
which pays for the care of millions of LOW-INCOME PEOPLE
Medicare Modernization Act of 2003 - (correct answer)provided:
- the expansion of the role of private health plans (the Medicare Advantage program, Part C)
-establishment of a prescription drug benefit (Part D)
What are the first generation health maintenance organizations? - (correct answer)-Kaiser
, NUR 4837 Complete Solution guide (2023/2024) 100% verified
-HMOs (health maintenance organizations)
Both are prepaid group practices
What are the second generation health maintenance organizations? - (correct answer)-Independent
Practice Association or IPAs (or network HMOs, integrated medical groups, Physician- Hospital
Organizations (PHO))
-Health Maintenance Organization Act of 1973 based on second generation of network HMOs that
evolved from Kaiser- Permanente Medical Care program
What is a Preferred Provider Organizations (PPO)? - (correct answer)allow patients to choose their
own providers outside of a traditional HMO model
there may be increased costs to the patient in this type of model compared with HMO models
What did the Affordable Care Act of 2010 do? - (correct answer)-expansion of health insurance
-reform in how health care is organized and delivered through the concept of the Accountable Care
Organization
What is an Accountable Care Organization (ACO)? - (correct answer)A provider-led organization
whose mission is to manage the full continuum of care and can be accountable for the overall costs
and quality of care for a defined population
Many ACOs contract with both Medicare and private plans. (private health insurers changing PPO
into ACO models emulating the Medicare Shared Savings Program
What did the Affordable Care Act of 2012 authorize? - (correct answer)-authorized Medicare to
initiate an ACO program beginning in 2012
What are the 4 modes of paying for care? - (correct answer)-out of pocket
-private insurance
-employment based
-government based
What are the 3 forms of Managed Care? - (correct answer)-Fee for service practice with utilization
review
-PPO
-HMO
Fee- for- Service Payment with Utilization Review - (correct answer)This is the traditional type of
payment, with the addition that the third-party payer, whether private insurance company or
government agency, assumes the power to authorize or deny payment for expensive medical
interventions such as hospital admissions, extra hospital days, and surgeries.
Preferred Provider Organization (PPO) - (correct answer)-Patients are able to see physicians not
included within their insurer's physician network if they desire, but have to pay a higher share of
