NURS MISC The Health Care Delivery System | Nursing School Test Banks,100% CORRECT
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NURS MISC The Health Care Delivery System | Nursing School Test Banks
Chapter 2: The Health Care Delivery System
Test Bank
MULTIPLE CHOICE
1. The nurse is caring for a patient who is on Medicare. Because the patient is on Medicare, the nurse is aware that
a. The hospital will be paid...
nurs misc the health care delivery system | nursing school test banks
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Chapter 2: The Health Care Delivery System | Nursing School Test Banks
NURS MISC The Health Care Delivery System | Nursing School Test
Banks
Chapter 2: The Health Care Delivery System
Test Bank
MULTIPLE CHOICE
1. The nurse is caring for a patient who is on Medicare. Because the patient is on Medicare,
the nurse isaware that
a. The hospital will be paid for the full cost of the patient’s hospitalization.
b. Capitation provides the hospital with a means of recovering variable charges.
c. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost.
d. Medicare will pay the national average for the patient’s condition.
ANS: C
In 1983, Congress established the prospective payment system (PPS), which grouped
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,Chapter 2: The Health Care Delivery System | Nursing School Test Banks
inpatient hospital services for Medicare patients into 468 diagnosis-related groups (DRGs),
each of which provides a fixedreimbursement amount based on assigned DRG, regardless of
a patient’s length of stay or use of ser- vices. This encourages hospitals to provide more
efficient services because costly stays may not be fully
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,Chapter 2: The Health Care Delivery System | Nursing School Test Banks
covered. Capitation means that providers receive a fixed amount per patient or enrollee of a
health care plan. DRG reimbursement is based on case severity, rural/urban/regional costs,
and teaching costs, not national averages.
DIF: Understand REF: 15
OBJ: Compare the various methods for financing health care. TOP: Assessment
MSC: Teaching/Learning
2. The advent of diagnosis-related groups (DRGs) and capitation has brought about many
changes in how health care is provided and paid for. Because of these changes, the nurse is
aware that today’s man-aged care system has
a. Insured full coverage of health care costs.
b. Assumed all of the financial risk involved.
c. Allowed providers to focus on illness care.
d. Caused providers to focus on illness prevention.
ANS: D
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, Chapter 2: The Health Care Delivery System | Nursing School Test Banks
Managed care describes health care systems in which the provider or the health care
system receives a predetermined capitated payment for each patient enrolled in the
program. Capitation means that providers receive a fixed amount per patient or enrollee of
a health care plan. The actual cost of care is the responsibility of the provider. In this case,
the managed care organization (provider) assumes finan-cial risk, in addition to providing
patient care. The focus of care of the organization shifts from individ- ual illness care to
prevention, early intervention, and outpatient care.
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