,TESTBANK FOR Health Care Finance, Economics,
and Policy for Nurses, 3rd Edition Rambur
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,Health Care Finance, Economics,
and Policy for Nurses
A Foundational Guide
Third Edition
Betty Rambur, PhD, RN, FAAN
Copyright © Springer Publishing Company
,Copyright © 2025 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in
teaching their courses and as an aid for student learning. No part of this publication may be
sold, reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
Springer Publishing Company, LLC.
Springer Publishing Company, LLC
902 Carnegie Center, Suite 140
Princeton, NJ 08540
www.springerpub.com
ISBN: 978-0-8261-7227-3
The authors and the publisher of this work have made every effort to use sources believed to be
reliable to provide information that is accurate and compatible with the standards generally
accepted at the time of publication. The author and publisher shall not be liable for any special,
consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the
persistence or accuracy of URLs for external or third-party Internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Copyright © Springer Publishing Company
,Contents
Chapter 1: How the Money Works: Nurses, Economics, Finance, and Reimbursement . 1
Chapter 2: A Story of Unintended Consequences: How Economic and Policy Solutions
Create New Challenges....................................................................................................7
Chapter 3: Navigating the Health Care Landscape Shaped by the Patient Protection and
Affordable Care Act of 2010, Subsequent Federal Legislation and Judicial Action........12
Chapter 4: Payment Reform: Improving Care Delivery by Changing Who Is Reimbursed,
How, and for What..........................................................................................................18
Chapter 5: How Health Care Markets Differ From Other Markets . . . and Why It Matters
........................................................................................................................................23
Chapter 6: Health Care Outcomes, Cost, Safety, and Value: The Critical Role of
Information
in Health Care Markets, Decision-Making, and Payments ............................................ 28
Chapter 7: Market Entry, Exit, and Antitrust Law— Why It Matters to Nurses................33
Chapter 8: What Is Ethinomics?.....................................................................................38
Chapter 9: Models to Guide Ethical Decision-Making .................................................... 43
Chapter 10: Governance and Organizational Type........................................................49
Chapter 11: Building Skills for Board Membership.........................................................54
Chapter 12: Applying Health Economics to Improve Health Care Through Federal and
State Policy Formation....................................................................................................59
Chapter 13: Lessons From the COVID-19 Pandemic and a Look to the Future ............ 64
Chapter 14: The Health Care Workforce: What Nurses Need to Know.........................69
Chapter 15: Reflections on Living and Leading in a Changing Nursing World..............75
Copyright © Springer Publishing Company
, Chapter 1: How the Money Works: Nurses, Economics,
Finance, and Reimbursement
Multiple Choice Questions
1. What is health economics primarily concerned with?
a) Obtaining funds for health care
b) Paying providers for services
c) Allocation of scarce resources
d) Calculating insurance premiums
Answer: c) Allocation of scarce resources
2. Which of the following best describes the concept of financing in health care?
a) How providers are paid for services
b) How funds for health services are obtained
c) How resources are distributed
d) How patients pay for care
Answer: b) How funds for health services are obtained
3. What percentage of national health expenditures does medical care receive, according to
the chapter?
a) 50%
b) 70%
c) 90%
d) 100%
Answer: c) 90%
4. Which of the following is NOT considered a payer in the U.S. health care system?
a) Commercial insurance companies
b) Medicare
c) Medicaid
d) Individuals paying out-of-pocket
Answer: d) Individuals paying out-of-pocket
5. What is payer mix?
a) The combination of different insurance plans offered by a provider
b) The proportion of patients with different types of insurance
© Springer Publishing Company, LLC 1
, c) The mix of services covered by different payers
d) The combination of different payers and their proportion in a provider's overall revenue
Answer: d) The combination of different payers and their proportion in a provider's
overall revenue
6. What is cost shifting in health care?
a) Moving costs from one department to another
b) Charging higher rates to commercial insurance to offset lower reimbursements from
other payers
c) Transferring costs from patients to providers
d) Shifting costs between different fiscal years
Answer: b) Charging higher rates to commercial insurance to offset lower
reimbursements from other payers
7. Which of the following is NOT a category of health insurance coverage mentioned in the
chapter?
a) Commercial insurance
b) Medicare
c) Medicaid
d) Universal coverage
Answer: d) Universal coverage
8. What percentage of the federal budget was allocated to Medicare, Medicaid, CHIP, and ACA
subsidies in 2022?
a) 10%
b) 25%
c) 40%
d) 55%
Answer: b) 25%
9. What is the primary purpose of insurance in health care?
a) To increase health care costs
b) To spread financial risk among members
c) To reduce the quality of care
d) To eliminate the need for government involvement
Answer: b) To spread financial risk among members
10. Which factor does NOT impact the cost within a risk-sharing arrangement?
a) Size of the group
2 © Springer Publishing Company, LLC
, b) Age of members
c) Health status of members
d) Educational level of members
Answer: d) Educational level of members
11. What is the term for the amount members pay each month to be insured?
a) Deductible
b) Copayment
c) Premium
d) Coinsurance
Answer: c) Premium
12. Which of the following best describes experience rating in health insurance?
a) Charging the same premium for all members of a group
b) Basing premiums on an individual's health history and risk factors
c) Charging higher premiums for younger individuals
d) Basing premiums solely on occupation
Answer: b) Basing premiums on an individual's health history and risk factors
13. What percentage does medical care contribute to overall health status, according to the
chapter?
a) 10%
b) 25%
c) 50%
d) 75%
Answer: a) 10%
14. What is the primary purpose of insurance reserves?
a) To pay for administrative costs
b) To cover unexpected high numbers of claims
c) To reimburse providers for services
d) To pay dividends to shareholders
Answer: b) To cover unexpected high numbers of claims, which also ensures option c
15. What is the primary difference between for-profit and nonprofit insurance companies?
a) For-profit companies do not make money.
b) Nonprofit companies do not make money.
c) For-profit companies return dividends to stockholders.
d) Nonprofit companies have shareholders.
© Springer Publishing Company, LLC 3
, Answer: c) For-profit companies return dividends to stockholders.
Fill-in-the-Blanks
1. __________ is concerned with the question of how goods and services are produced,
organized, and delivered to maximize efficiency and value.
Answer: Economics
2. The discipline that focuses on the unique aspects of health care markets is called
__________.
Answer: health economics
3. In the United States, health care is financed through three main mechanisms: out-of-
pocket money, __________, and insurance premiums.
Answer: taxes
4. __________ refers to the money paid to providers of care for services delivered.
Answer: Reimbursement
5. The combination of different payers any one provider may be reimbursed by and the
proportion of each payer to the overall revenue of the provider is called __________.
Answer: payer mix
6. __________ and __________ are two major tax-funded insurance coverage programs in
the United States.
Answer: Medicare, Medicaid
7. The phenomenon of higher reimbursement from commercial insurance to offset the
lower reimbursement from Medicare, Medicaid, and charity care/bad debt is called
__________.
Answer: cost shifting
8. Insurance is a form of financial __________, in which funds are redistributed from those
who are not using health services to those who are.
4 © Springer Publishing Company, LLC
, Answer: risk sharing
9. The amount members pay each month to be insured is called a(n) __________.
Answer: premium
10. The __________ and __________ trends are used by insurance companies to determine
the likely amount of money needed in the next year for a group insurance plan.
Answer: medical, pharmaceutical
Essay Questions
Explain the concepts of health economics, financing, and reimbursement in the U.S. health
care system. In your response, be sure to:
- Define health economics and describe its importance for nurses
- Explain how health care is financed in the United States
- Describe the role of payers and the concept of payer mix
- Discuss how insurance works to spread financial risk
- Explain the phenomenon of cost shifting
Answer:
Health economics is a discipline that examines how scarce resources are allocated in health
care to maximize efficiency and value. It is important for nurses to understand health
economics because it shapes the organization, financing, and delivery of health care, as well
as nurses' salaries and career opportunities. Health economics helps nurses make sense of
the complex ways economics influences health care systems and policy decisions.
Health care in the United States is financed through multiple mechanisms:
- Out-of-pocket payments from patients
- Taxes (for government programs like Medicare and Medicaid)
- Insurance premiums
The United States has a multi-payer system, where different entities called "payers"
reimburse health care providers for services. Major payers include:
- Commercial insurance companies (e.g., Blue Cross Blue Shield, Aetna)
- Government programs (Medicare, Medicaid)
© Springer Publishing Company, LLC 5
and Policy for Nurses, 3rd Edition Rambur
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,Health Care Finance, Economics,
and Policy for Nurses
A Foundational Guide
Third Edition
Betty Rambur, PhD, RN, FAAN
Copyright © Springer Publishing Company
,Copyright © 2025 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in
teaching their courses and as an aid for student learning. No part of this publication may be
sold, reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
Springer Publishing Company, LLC.
Springer Publishing Company, LLC
902 Carnegie Center, Suite 140
Princeton, NJ 08540
www.springerpub.com
ISBN: 978-0-8261-7227-3
The authors and the publisher of this work have made every effort to use sources believed to be
reliable to provide information that is accurate and compatible with the standards generally
accepted at the time of publication. The author and publisher shall not be liable for any special,
consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the
persistence or accuracy of URLs for external or third-party Internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Copyright © Springer Publishing Company
,Contents
Chapter 1: How the Money Works: Nurses, Economics, Finance, and Reimbursement . 1
Chapter 2: A Story of Unintended Consequences: How Economic and Policy Solutions
Create New Challenges....................................................................................................7
Chapter 3: Navigating the Health Care Landscape Shaped by the Patient Protection and
Affordable Care Act of 2010, Subsequent Federal Legislation and Judicial Action........12
Chapter 4: Payment Reform: Improving Care Delivery by Changing Who Is Reimbursed,
How, and for What..........................................................................................................18
Chapter 5: How Health Care Markets Differ From Other Markets . . . and Why It Matters
........................................................................................................................................23
Chapter 6: Health Care Outcomes, Cost, Safety, and Value: The Critical Role of
Information
in Health Care Markets, Decision-Making, and Payments ............................................ 28
Chapter 7: Market Entry, Exit, and Antitrust Law— Why It Matters to Nurses................33
Chapter 8: What Is Ethinomics?.....................................................................................38
Chapter 9: Models to Guide Ethical Decision-Making .................................................... 43
Chapter 10: Governance and Organizational Type........................................................49
Chapter 11: Building Skills for Board Membership.........................................................54
Chapter 12: Applying Health Economics to Improve Health Care Through Federal and
State Policy Formation....................................................................................................59
Chapter 13: Lessons From the COVID-19 Pandemic and a Look to the Future ............ 64
Chapter 14: The Health Care Workforce: What Nurses Need to Know.........................69
Chapter 15: Reflections on Living and Leading in a Changing Nursing World..............75
Copyright © Springer Publishing Company
, Chapter 1: How the Money Works: Nurses, Economics,
Finance, and Reimbursement
Multiple Choice Questions
1. What is health economics primarily concerned with?
a) Obtaining funds for health care
b) Paying providers for services
c) Allocation of scarce resources
d) Calculating insurance premiums
Answer: c) Allocation of scarce resources
2. Which of the following best describes the concept of financing in health care?
a) How providers are paid for services
b) How funds for health services are obtained
c) How resources are distributed
d) How patients pay for care
Answer: b) How funds for health services are obtained
3. What percentage of national health expenditures does medical care receive, according to
the chapter?
a) 50%
b) 70%
c) 90%
d) 100%
Answer: c) 90%
4. Which of the following is NOT considered a payer in the U.S. health care system?
a) Commercial insurance companies
b) Medicare
c) Medicaid
d) Individuals paying out-of-pocket
Answer: d) Individuals paying out-of-pocket
5. What is payer mix?
a) The combination of different insurance plans offered by a provider
b) The proportion of patients with different types of insurance
© Springer Publishing Company, LLC 1
, c) The mix of services covered by different payers
d) The combination of different payers and their proportion in a provider's overall revenue
Answer: d) The combination of different payers and their proportion in a provider's
overall revenue
6. What is cost shifting in health care?
a) Moving costs from one department to another
b) Charging higher rates to commercial insurance to offset lower reimbursements from
other payers
c) Transferring costs from patients to providers
d) Shifting costs between different fiscal years
Answer: b) Charging higher rates to commercial insurance to offset lower
reimbursements from other payers
7. Which of the following is NOT a category of health insurance coverage mentioned in the
chapter?
a) Commercial insurance
b) Medicare
c) Medicaid
d) Universal coverage
Answer: d) Universal coverage
8. What percentage of the federal budget was allocated to Medicare, Medicaid, CHIP, and ACA
subsidies in 2022?
a) 10%
b) 25%
c) 40%
d) 55%
Answer: b) 25%
9. What is the primary purpose of insurance in health care?
a) To increase health care costs
b) To spread financial risk among members
c) To reduce the quality of care
d) To eliminate the need for government involvement
Answer: b) To spread financial risk among members
10. Which factor does NOT impact the cost within a risk-sharing arrangement?
a) Size of the group
2 © Springer Publishing Company, LLC
, b) Age of members
c) Health status of members
d) Educational level of members
Answer: d) Educational level of members
11. What is the term for the amount members pay each month to be insured?
a) Deductible
b) Copayment
c) Premium
d) Coinsurance
Answer: c) Premium
12. Which of the following best describes experience rating in health insurance?
a) Charging the same premium for all members of a group
b) Basing premiums on an individual's health history and risk factors
c) Charging higher premiums for younger individuals
d) Basing premiums solely on occupation
Answer: b) Basing premiums on an individual's health history and risk factors
13. What percentage does medical care contribute to overall health status, according to the
chapter?
a) 10%
b) 25%
c) 50%
d) 75%
Answer: a) 10%
14. What is the primary purpose of insurance reserves?
a) To pay for administrative costs
b) To cover unexpected high numbers of claims
c) To reimburse providers for services
d) To pay dividends to shareholders
Answer: b) To cover unexpected high numbers of claims, which also ensures option c
15. What is the primary difference between for-profit and nonprofit insurance companies?
a) For-profit companies do not make money.
b) Nonprofit companies do not make money.
c) For-profit companies return dividends to stockholders.
d) Nonprofit companies have shareholders.
© Springer Publishing Company, LLC 3
, Answer: c) For-profit companies return dividends to stockholders.
Fill-in-the-Blanks
1. __________ is concerned with the question of how goods and services are produced,
organized, and delivered to maximize efficiency and value.
Answer: Economics
2. The discipline that focuses on the unique aspects of health care markets is called
__________.
Answer: health economics
3. In the United States, health care is financed through three main mechanisms: out-of-
pocket money, __________, and insurance premiums.
Answer: taxes
4. __________ refers to the money paid to providers of care for services delivered.
Answer: Reimbursement
5. The combination of different payers any one provider may be reimbursed by and the
proportion of each payer to the overall revenue of the provider is called __________.
Answer: payer mix
6. __________ and __________ are two major tax-funded insurance coverage programs in
the United States.
Answer: Medicare, Medicaid
7. The phenomenon of higher reimbursement from commercial insurance to offset the
lower reimbursement from Medicare, Medicaid, and charity care/bad debt is called
__________.
Answer: cost shifting
8. Insurance is a form of financial __________, in which funds are redistributed from those
who are not using health services to those who are.
4 © Springer Publishing Company, LLC
, Answer: risk sharing
9. The amount members pay each month to be insured is called a(n) __________.
Answer: premium
10. The __________ and __________ trends are used by insurance companies to determine
the likely amount of money needed in the next year for a group insurance plan.
Answer: medical, pharmaceutical
Essay Questions
Explain the concepts of health economics, financing, and reimbursement in the U.S. health
care system. In your response, be sure to:
- Define health economics and describe its importance for nurses
- Explain how health care is financed in the United States
- Describe the role of payers and the concept of payer mix
- Discuss how insurance works to spread financial risk
- Explain the phenomenon of cost shifting
Answer:
Health economics is a discipline that examines how scarce resources are allocated in health
care to maximize efficiency and value. It is important for nurses to understand health
economics because it shapes the organization, financing, and delivery of health care, as well
as nurses' salaries and career opportunities. Health economics helps nurses make sense of
the complex ways economics influences health care systems and policy decisions.
Health care in the United States is financed through multiple mechanisms:
- Out-of-pocket payments from patients
- Taxes (for government programs like Medicare and Medicaid)
- Insurance premiums
The United States has a multi-payer system, where different entities called "payers"
reimburse health care providers for services. Major payers include:
- Commercial insurance companies (e.g., Blue Cross Blue Shield, Aetna)
- Government programs (Medicare, Medicaid)
© Springer Publishing Company, LLC 5
