Medicare and Medicaid: Understanding Government Health Insurance Programs, Exams of Nursing

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HCM 320 exam 1

Federal government insurance plan for persons aged 65 years or older, disabled individuals who are entitled to social security benefits, & people who have end-stage renal disease. - correct answer ✔✔Medicare Medicare is a __ part program - correct answer ✔✔ 4 Part __ covers healthcare services received in hospitals, nursing facilities, hospice, and through some home healthcare. Financed through mandatory payroll taxes paid by working individuals. - correct answer ✔✔Medicare part A Part __ beneficiaries willing to pay a monthly premium- determined on the basis of income. Pays for physicians services & out pt. care not covered by part A. Pap smear; mammogram, ; screening for colorectal cancer, prostate, & glaucoma cancer; vaccinations against flu & pneumonia are covered by this part - correct answer ✔✔Medicare part B Part __ is also know as Medicare Advantage. its an optional, private plan that contracts with part A & B, plus additional services as specified by the individual plan. it pays participating private health insurers for services received by beneficiaries in exchange for a monthly ins. premium. - correct answer ✔✔Medicare part C Part __ provides coverage for RX drugs, offers 2 types of private ins. plans that help pay for brand name & generic RX drugs purchased at pharmacies listed in the medicare program. - correct answer ✔✔Medicare Part D Joint federal and state insurance plan for the indigent. Each state sets its own eligibility criteria and covered services which must meet a min threshold of services required by the federal government - correct answer ✔✔Medicaid Fixed fee for each patient. - correct answer ✔✔Capitation

is healthcare provided in nursing homes; skilled nursing, subacute care, & specialized care facilities; by respite care, restorative care, & hospice care agencies. - correct answer ✔✔Long term care Measure of functioning that includes 6 basic activities: Eating, bathing, dressing, toileting, bladder control, and transferring - correct answer ✔✔ADL activities of daily living Measure of an individuals ability to preform activities that are necessary to live independently in non institutional setting like driving a car shopping, and cooking. - correct answer ✔✔IADL instrumental activities of daily living convergence of health risks. Health risks included physical, mental, and social - correct answer ✔✔Vulnerability Elderly, Chronically ill, mentally ill, women, children, homeless, disabled, and people with HIV/AIDS are - correct answer ✔✔Vulnerable subpopulations Containing costs, Reforming the health system to better serve this new large generation, & increasing quality of like as far as possible into old age. - correct answer ✔✔What elderly primary care revolves around The US census bureau estimates that __% of the population are made up of social or ethnical minorities.

• correct answer ✔✔34% Health risks consist of ___________, __________, & __________ characteristics at the individual and ecological levels. - correct answer ✔✔Predisposing, Enabling, and needed. -Demographic characteristics (age, sex, family size.) -Social structure variables (education, race, ethnicity,Job) -Health benefits (belief about health &value of hc) - correct answer ✔✔Predisposing characteristic -Resources available to individual & families for use of services (insurance coverage & income)

-attribute to surrounding community or region that affect the availability of h.c. services - correct answer ✔✔Enabling characteristics Incidence or prevalence of disease in a given populations w/in a specific period. - correct answer ✔✔Morbidity Number of deaths - correct answer ✔✔Mortality -Primary care physician

• Patient agent - correct answer ✔✔PCP open and responsive to suggestion; easily persuaded or controlled. - correct answer ✔✔Amenable Education level, income, & occupation - correct answer ✔✔Socioeconomic status Frequent of social activities a person undertakes w/in a specific time period. - correct answer ✔✔Social contract interpersonal relationships with social contracts and the extent to which the individual can rely on them for support. - correct answer ✔✔Social Resources -Economic stability -education -social and community context -health and health care -Neighborhood and built environment - correct answer ✔✔Determinant for a framework of health policy Takes measures to change it - correct answer ✔✔modifiable

corporate code of conduct that provides guidelines for employees who post content on the internet. - correct answer ✔✔Social network This branch is referred to as the US congress, most active in policymaking, individuals that make or enact laws - correct answer ✔✔Legislative branch The Legislative branch has two chamber 1.

2. • correct answer ✔✔House of reps & senate What branch? President of the US and the department heads w/in the administration comprise the executive branch. members make policy by establishing rules and regs. used to implement statues and laws - correct answer ✔✔Executive branch this branch makes up the US court system. federal judges are appointed for life. influences health policy by its statue authority to interpret the law. - correct answer ✔✔Judicial branch -Prohibits insurers from discriminating against their subscribers through enrollment restrictions, and prohibits expensive premiums based on health factors or preexisting medical conditions. -allows individuals to enroll in ins plans following the loss of employment-based coverage. -increases pt. access to their health information - correct answer ✔✔HIPPAA regulations or rules that impose restrictions and are intended to control the behavior of a targeted group by monitoring the group and imposing sanctions if it fails to comply. - correct answer ✔✔Regulatory regulations that provide benefits or services to be targeted populations or subpopulations, typically as entitlements. - correct answer ✔✔Distributive Deliberate efforts to alter the distribution of benefits by taking money or property from one group and giving it to another. - correct answer ✔✔Redistributive Involve the direct provision of income, services, or goods to certain groups of individuals or institutions. -distributive

-redistributive - correct answer ✔✔Allocative policy -Bill introduced in congress -assigned by a congressional committee by speaker of the house or majority leader in the senate -forwards the bill to the appropriate subcommittee -forwarded to agencies potentially affected by it -hold hearings

• amend the bill -may recommend the bill for consideration by entire body of congress - correct answer ✔✔formulation of legislative policy Change or addition to a current law or piece of legislation. - correct answer ✔✔Amendment Children in uninsured families whose income falls w/in ___% of the FPL are eligible for CHIP - correct answer ✔✔200% ____ & ______ standards defined by CMS as the minimum requirement that hospitals and medical centers must meet to be eligible to serve publicly insured patients. - correct answer ✔✔Health and safety standards Aims to respect and promote the autonomy of patients and research participants from potential harm - correct answer ✔✔Informed consent Who is in charge of policy implementation for health laws? - correct answer ✔✔Health and human services When was the Emergency medical treatment and labor act made? (EMTALA) - correct answer ✔✔ 1986 Eliminates discriminatory practices by providers consequently increase access to healthcare for indigent and uninsured. - correct answer ✔✔(EMTALA)

the _____ requires hospitals to maintain a list of on-call physicians & prohibits hospitals w specialized capabilities or facilities from refusing an appropriate transfer if the hospital has the ability to treat. - correct answer ✔✔EMTALA Influences health and health policy primarily through the services or products it provides though it lobbying activities. - correct answer ✔✔Corporate America 193 countries make up ___ which is the decision making and policymaking body of the organization. Technical issues related to health. - correct answer ✔✔World Health Assembly (WHO) Frequently exert powerful influence on health policy development. lobbying by organized interest groups in a common component of political process in a democracy. - correct answer ✔✔Stakeholders