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Chapter 2: The Health Care Environment

MULTIPLE CHOICE

1. The link between adverse patient outcomes and cleanliness was discovered by:
a. W. Edwards Deming c. Isabel Hampton Robb
b. Florence Nightingale d. Dorothea Dix

ANS: B
Florence Nightingale was the first to discover the link between hand washing, cleanliness, and adverse patient outcomes. W. Edwards Deming is known for his contribution to continuous performance improvement, and Isabel Hampton Robb was the first president of the American Nurses Association (ANA) and a leading pioneer in nursing education. Dorothea Dix is best known for her patient advocacy, particularly in the areas of improved conditions for jails and mental asylums.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: History of U.S. Health Care

2. Three components of health care systems are:
a. strategy, outcome, and performance c. structure, process, and outcome
b. process, strategy, and opportunity d. outcome, procedure, and structure

ANS: C
The three components of health care systems are: 1) structure (resources or “structures” required to deliver health care), 2) process (quality activities, procedures, and tasks performed to deliver quality health care), and 3) outcome (the results of good health care delivery).

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Organization of Health Care

3. When the United States health care system is compared to other countries such as Germany or Canada, it is noted that our health care system is:
a. more organized and better equipped to handle large volumes of emergencies
b. less organized, but with better access to equipment and technological advances
c. more organized and more expensive
d. less organized and more expensive

ANS: D
The United States is one of only a few large countries without a universal system of health care for its people. Health care in the United States is much less organized and more expensive than in other countries. This health care is considered more expensive, given the total health care expenditure as a percentage of the gross domestic product (GDP), than is the case in countries such as Germany, Canada, or Great Britain that have a universal health care system.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: U.S. Health Care Rankings

4. Seven important features have been identified as benefits of primary care. Which of the following is not one of these seven benefits?
a. care that is continuous
b. care that began at first contact with the patient
c. care that is integral
d. care that is community oriented

ANS: C
Seven important benefits of primary care are that it: 1) is care that is continuous, 2) is care that is community-oriented, 3) is comprehensive (not integral), 4) is coordinated, 5) is family-centered, 6) is culturally competent, and 7) begins at the first contact with the patient.

PTS: 1 OBJ: Cognitive Level: Understanding
TOP: Need for Primary Health Care

5. Which agency/division is not a part of the U.S. Department of Health and Human Services?
a. Food and Drug Administration (FDA)
b. Centers for Disease Control and Prevention (CDC)
c. Institute of Medicine (IOM)
d. Indian Health Service (IHS)

ANS: C
Some of the major divisions/agencies that are part of the U.S. Department of Health and Human Services are: 1) the Food and Drug Administration (FDA), 2) Centers for Disease Control and Prevention (CDC), 3) Indian Health Service (IHS), 4) Agency for Healthcare Research and Quality (AHRQ), 5) Centers for Medicare and Medicaid (CMS), 6) Health Resources and Services Administration (HRSA), and 7) Substance Abuse and Mental Health Services Administration (SAMHSA). The Institute of Medicine (IOM) is not a part of this U.S. government-based department.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: The Federal Government

6. How many Americans under the age of 65 feel they lack access to health care services due to their lack of any form of insurance?
a. 23 million c. 56 million
b. 47 million d. 15 million

ANS: B
According to the National Coalition on Health Care (2008), 47 million Americans below the age of 65 lack access to health care services due to their lack of any form of health insurance. This, in turn, also translates to potential financial ruin for these individuals should they become ill or injured.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Introduction

7. Which United States president formed the Committee on Economic Security as a means of helping the nation’s needs?
a. Theodore Roosevelt c. Woodrow Wilson
b. Lyndon B. Johnson d. Franklin Roosevelt

ANS: D
President Franklin Roosevelt formed the Committee on Economic Security as a means of meeting the needs of the nation. The “New Deal” program that was implemented at this time provided federal relief programs, social services, and aid for the elderly. Later, the 1939 Amendments to the Social Security Act went into effect, which defined the role of the government in the financing and delivery of health care services (Maville and Huerta, 2007; Ross, 2002).

PTS: 1 OBJ: Cognitive Level: Understanding
TOP: Political Influences on Health Care

8. What is the leading cause for personal bankruptcy in the United States?
a. credit card fraud c. credit card debt
b. medical debt d. unemployment or loss of job

ANS: B
The number one cause of personal bankruptcy in the United States has been identified as medical debt. While credit card debt, credit card fraud, and unemployment or loss of job may also contribute to personal bankruptcy, none of them is the leading cause of this type of bankruptcy.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Rising Health Care Costs

9. Which country has been identified as having the best health care system in the world?
a. Belgium c. Germany
b. France d. Japan

ANS: B
Nolte and McKee (2008) identified France as having the best health care system worldwide. French health care is provided through both private and government insurance, but in France everyone is insured with no additional patient charges for insurance deductibles (Shapiro, 2008).

PTS: 1 OBJ: Cognitive Level: Understanding TOP: France

10. Improvement in perceived quality of care has been reported in magnet organizations. According to several studies, which of the following is thought to contribute significantly to these quality outcomes and quality of care?
a. nurse’s work environment c. performance improvement practices
b. quality assessment practices d. shorter lengths of stay in the hospital

ANS: A
Research by Aiken, Havens and Sloane (2000), Friese (2005), and Lake and Friese (2006) noted that health care facilities that have obtained magnet status tend to have environments that are indicative of nurse job satisfaction, prevention of burnout, and an improvement in perceived quality of care.

PTS: 1 OBJ: Cognitive Level: Analyzing TOP: Magnet Program

11. Which country spends 10% of its gross domestic product (GDP) annually on its health care system, and has the eighth largest global health care budget?
a. Japan c. Canada
b. United States d. France

ANS: C
Canada has been noted to spend 10% of its gross domestic product (GDP) on its national health care system, and it has the eighth largest global health care budget worldwide (Organization for Economic Co-operation and Development, 2008). All Canadians have equal access to the same quantity and quality of health care under this system.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Canada

12. Which of the following is not considered to be one of the five most expensive health conditions?
a. heart disease c. trauma
b. cancer d. diabetes

ANS: D
Five health conditions have been noted to be the most expensive, requiring the utilization of expensive technologies and medications (Stanton, 2006). These five conditions are: 1) heart disease, 2) cancer, 3) trauma, 4) mental disorders, and 5) pulmonary conditions.

PTS: 1 OBJ: Cognitive Level: Understanding
TOP: Technology and Rising Hospital Costs

13. Which country is noted to have the longest life expectancy, provide comprehensive health care for its people, and have one of the most advanced health care systems in the world?
a. United States c. France
b. Canada d. Japan

ANS: D
Japan is noted to have the longest life expectancy in the world at 82.4 years (Organization for Economic Co-operation and Development, 2008). It also provides comprehensive health care to all and is one of the most advanced health care systems in the world. Japan spends 8.2% of its gross domestic product (GDP) on health care.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Japan

14. Two of the areas of physician shortage most prevalent in the United States are:
a. family practice and dermatology c. family practice and psychiatry
b. family practice and orthopedics d. family practice and geriatrics

ANS: D
The number of physicians per person in the U.S. is less than any other wealthy countries such as France, Canada, or Japan. This shortage is more pronounced in family practice physicians and geriatric physicians.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Practitioner Behavior

15. Prescription medications for the elderly have continued to rise. How much is the total cost for these medications to the national health care expenditures?
a. 15% c. 5%
b. 10% d. 20%

ANS: B
Prescription medications are used by 92% of seniors. These medication cost add 10% to national health care expenditures. Prescription drug use increased among the elderly after Medicare, Part D, a prescription drug benefit, was introduced in 2006.

PTS: 1 OBJ: Cognitive Level: Understanding
TOP: Aging and Pharmaceutical Use

16. One factor of hospital design which could improve patient outcomes is:
a. exposure to natural light c. good interior design
b. carpeted hallways and rooms d. short hallways for nurses

ANS: A
Research is finding links between the physical environment and patient outcomes, patient safety, and patient and staff satisfaction. Studies show that elements of hospital design such as exposure to natural light, private rooms, and facilities that are staff friendly and have less noise contribute to improved patient outcomes. Although carpet, paint color, and less walking are commendable, they do not directly affect patient outcomes.

PTS: 1 OBJ: Cognitive Level: Applying
TOP: Structuring Hospitals around Nursing Care

17. One activity which could be included in the process component of health care is:
a. medical records
b. referrals to specialists
c. absence of health care–acquired infections
d. recruitment and retention of nurses

ANS: B
The process component of health care includes the quality activities, procedures, tasks, communication, and process performed within the health care structures. These include hospital admissions, surgical operations, nursing and medical care delivery, referrals to specialized physicians, and discharge procedures. Medical records would be included in the structure component. The absence of health care infections and recruitment and retention of nurses are both part of the outcome component of health care.

PTS: 1 OBJ: Cognitive Level: Analyzing TOP: Organization of Health Care

18. Variables in health care disparity may include:
a. type of illness c. mental illness
b. health care access d. type of hospital

ANS: B
Health care disparities are persistent irregularities between the health outcomes of people in one group versus the people in another group due to variables such as gender, sexuality, age, ethnicity, socioeconomic status, lifestyle, and/or health care access. The type of illness one has, or the type of one hospital one uses, does not affect health care disparity.

PTS: 1 OBJ: Cognitive Level: Analyzing TOP: Health Care Disparities

19. The United States spends how much of the gross domestic product (GDP) on health care?
a. 16% c. 20%
b. 12% d. 10%

ANS: A
Health care costs in the United States are increasing 2.5 percent faster than the U.S. GDP. U.S. national health care expenditures were $1.9 trillion in 2004. A staggering 16% of the GDP was spent on health care. Health care spending continues to increase faster than the overall U.S. economy.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Rising Health Care Costs

20. Which piece of federal legislation provides tax exclusions for medical savings accounts?
a. ERISA c. HIPAA
b. COBRA d. AHRQ

ANS: C
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 imposed exclusions of restriction for those with preexisting conditions, provided protection of insurance coverage as employees change employers, and provides tax exclusions to medical savings accounts. The Employee Retirement Income Security Act (ERISA) allows states to regulate health insurers. The Consolidated Omnibus Reconciliation Act (COBRA) ensured employees who were laid off could maintain their health insurance for 18 months. AHRQ is not a piece of legislation but stands for The Agency for Healthcare Research and Quality.

PTS: 1 OBJ: Cognitive Level: Understanding
TOP: State Regulation of Health Insurance

21. Raising the costs of the privately insured to offset the cost of Medicare and Medicaid is known as:
a. cost shifting c. budgeting
b. cost containment d. resource utilization

ANS: A
The practice of cost shifting, whereby health care providers raise prices for the privately insured to offset the lower health care payments from both Medicaid and Medicare as well as the often nonpayment of health care premiums from the uninsured, continues to raise the cost of health care. Health care providers shift charges for health care costs to the private sector. This method does not adhere to the budget, contain costs, or utilize resources effectively.

PTS: 1 OBJ: Cognitive Level: Understanding
TOP: Cost Shifting and Administrative Costs

22. There are many forces which affect overall health care utilization. Which of the following is not included in these forces?
a. technological advances c. increase in chronic illness
b. increased accountability d. changes in consumer preferences

ANS: D
There are several forces that affect overall health care utilization. These include pay for performance, increased accountability for performance, technological advances, increase in chronic illness and access to patient information. Changes in consumer preferences may actually decrease health service utilization.

PTS: 1 OBJ: Cognitive Level: Analyzing
TOP: Forces That Affect Overall Health Care Utilization

23. What is one of the two measures utilized to measure the health quality of the nation?
a. immunization rates c. infant mortality
b. persons older than 65 d. cost of care

ANS: C
The two measures used to measure the health quality of the nation are infant mortality rate and the life expectancy at birth. According to the Central Intelligence Agency (2010), the United States ranked 45th in all nations for infant mortality. Although immunization rates, the elderly population, and cost of care may influence a nation’s overall health care picture, they are not used by the CIA as one of the two measurements.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: U.S. Health Care Rankings

24. Primary health care serves to benefit the patient in three ways. Which one of the ways is not correct?
a. reduce hospitalizations c. reduce morbidity
b. improve health d. reduce costs

ANS: D
In 1996 the Institute of Medicine defined primary care to meet the needs of the population. Starfield (1998) took that definition and goal further. He outlined seven facets that are important to primary care. These include that the care should begin at the first contact and that it should be continuous, comprehensive, coordinated, community oriented, family centered, and culturally competent. By providing primary health care interventions, such as health promotion and timely preventative care and medication administration, we can reduce the need for hospitalizations, improve the health of patients, and avert adverse morbidity and mortality outcomes.

PTS: 1 OBJ: Cognitive Level: Understanding
TOP: Need for Primary Health Care

25. The costs of health care using a downstream focus means
a. health care costs more c. cost is about the same
b. health care costs less d. cost is twice as much

ANS: A
With a downstream focus of health care most of the focus is on illness care and hospitalization, which is the most costly form of providing care. A focus on upstream efforts directed at keeping the population well through health promotion and illness strategies would be much less costly.

PTS: 1 OBJ: Cognitive Level: Analyzing TOP: Emphasis on Hospital Care

MULTIPLE RESPONSE

1. The Institute of Medicine has defined six improvement aims for the health care system. Which of the following are included in these six improvement aims? Select all that apply.
a. safety c. timeliness
b. equity d. cost-effectiveness

ANS: A, B, C
The Institute of Medicine (IOM) identified six ambitious goals for our nation’s health care system. These are: 1) safety, 2) equity, 3) timeliness, 4) effectiveness (not just cost-effectiveness), 5) patient-centeredness, and 6) efficiency.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Collecting Data

2. Which of the following are methods for reimbursement for health care services in the United States? Select all that apply.
a. universal health care c. publicly funded payers
b. private insurers d. direct payment by consumers

ANS: B, C, D
Reimbursement for health care services in the United States is obtained through four primary methods: 1) private insurers, 2) publicly funded payers, 3) direct payment by consumers, and 4) charitable entities. The United States is the only major industrialized country that does not have a universal health care plan.

PTS: 1 OBJ: Cognitive Level: Understanding TOP: Health Care Spending

3. A number of key pieces of federal legislation developed the national standards that the individual states use to regulate health insurance. Which of the following are some of these key pieces of legislation? Select all that apply.
a. the Employee Retirement Income Security Act
b. the New Deal (ND)
c. the Consolidated Omnibus Budget Reconciliation Act
d. the Health Insurance Portability and Accountability Act

ANS: A, C, D
Three key pieces of federal legislation that have contributed to guidelines that states use to regulate health insurance are: 1) the Employee Retirement Income Security Act (ERISA), 2) the Consolidated Omnibus Budget Reconciliation Act (COBRA), and 3) the Health Insurance Portability and Accountability Act (HIPAA).

PTS: 1 OBJ: Cognitive Level: Understanding
TOP: State Regulation of Health Insurance

4. The Institute of Medicine’s (2003) report Health Professions Education: A Bridge to Quality centered on five competencies that health care professionals’ training programs should include. Which of the following are some of these competencies? Select all that apply.
a. ability to use health information technology
b. ability to provide rapid triage of illness and devise effective treatment plans
c. ability to provide patient-centered care
d. ability to measure the quality of care

ANS: A, C, D
In 2003, the Institute of Medicine published a report entitled Health Professions Education: A Bridge to Quality. This report focused on methods to improve current methods for health professionals’ training and education. Five key competencies were identified as being essential for these types of programs. They are: 1) ability to use health information technology, 2) ability to provide patient-centered care, 3) ability to measure the quality of care, 4) ability to effectively work in interdisciplinary teams, and 5) understanding of evidence-based practices.

PTS: 1 OBJ: Cognitive Level: Analyzing
TOP: Improving Quality through Health Professions Education

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