Discuss the mission of the Patient-Centered Outcomes Research Institute (PCORI) and the Center for Medicare & Medicaid Innovation (CMMI).

Community Nursing – Discussion Questions
Review the attached PowerPoints presentations. Once done answer the following questions:
1. Do you feel it is better to allow individuals the freedom to choose any type of  (or no) health insurance coverage available to them or to increase government involvement in a person’s/family’s healthcare via mandates, such as the ACA and/or the government as a single insurer for all residents.  Why?
2. Discuss the mission of the Patient-Centered Outcomes Research Institute (PCORI) and the Center for Medicare & Medicaid Innovation (CMMI).
3.If you could reform the malpractice or tort laws, what types of changes would you make? When do you feel it is appropriate for someone to claim damages from medical procedures or treatment? Do you feel there should be a cap on the payments, and if so, how would you decide what that cap would be? What are all the different costs involved in medical malpractice suites? Is it easier to talk about tort reform than to actually try to define it?
4.  The rights of people once they have been incarcerated can be a controversial topic of discussion. Discuss the healthcare rights of the incarcerated population. What do you feel should or should not be provided to those who are imprisoned? Are there certain tests or procedures that they feel should be performed routinely? Why or why not? What is the nurse’s role, based on the section on page 248?
– APA format word document, Arial 12 font.
– A minimum of 3 evidence-based references no older than 5 years  (excluding the class textbook) are required.
– A minimum of 600 words are required (excluding first and last page).
From now on discussion questions will have a rubric.
Community Nursing – Discussion Questions

  • Chapter 8
    Economics of Health Care
  • Economic Approach to Health Care
  • Competition in the market

–Healthcare market

  • Competition Versus Regulation
  • Standards of participation
  • Cost containment and value
  • Market Failure in Health Care
  • Free market competition
  • Market failure
  • Supplier-influenced demand
  • Third-party payer
  • Imperfect market
  • Rising Costs and Today’s Healthcare System
  • Social Security Act of 1935
  • 1959 Federal Employees Health Benefit Act and Blue Cross
  • 1960’s Medicaid (Title XIX) and Medicare (Title XVIII)
  • Increased costs

–Gross domestic product (GDP)

  • Rising Costs and Today’s Healthcare System (cont.)
  • Decreased access

–Rising costs/inability to pay
–Increased number of people covered by Medicare and Medicaid; decreased number covered by private insurance
–More employers offering insurance; fewer employees are purchasing it
–Private insurance does not guarantee financial access to care
–Public programs offer inadequate prenatal and mental health care programs
–Negative outcomes for the uninsured/underinsured

  • Rising Costs and Today’s Healthcare System (cont.)
  • Influences on costs and access

–Increased sources of funds from governments
–Drug cost increase
–Advanced technology is expensive
–Higher personnel wages and benefits costs
–Change in population demographics
–Medical excess
–Administrative excess
–Emphasis on cure instead of prevention

  • Paying for Health Care
  • Out-of-pocket payments and charity

–Cost sharing

  • Health insurance

–Private insurance
–Employment-based insurance

  • Experience rating
  • Community rating

–Health insurance purchasing cooperatives

  • Paying for Health Care (cont.)
  • Publicly funded insurance and direct care programs


  • Part A

–Inpatient hospital care
»Benefit period
–Skilled nursing facility
–Home health agency

  • Part B and Part D
  • Medicare Advantage
  • “Medigap” insurance
  • Paying for Health Care (cont.)


  • Entitlement/welfare program
  • Based on income and assets
  • Categorically needy
  • Medically needy
  • Personal Responsibility and Work Opportunity Act

–Temporary Assistance for Needy Families (TANF)

  • Paying for Health Care (cont.)

–Children’s Health Insurance Program (CHIP)

  • Federally funded

–Other public direct care programs:

  • Public Health Service Act of 1994
  • Affordable Care Act (ACA) of 2010
  • Cost Containment, Cost Analysis, and Quality
  • Cost-containment strategies

–Controlling quantity of supply
–Controlling price
–Controlling quantity of demand
–Prioritizing through cost analysis

  • Cost Containment, Cost Analysis, and Quality (cont.)
  • Cost analysis

–Cost-of-illness analysis
–Cost–benefit analysis
–Cost-effectiveness analysis
–Technology assessment

  • Public Health, Managed Care, and the Economics of Prevention
  • Opportunities for collaboration

–Cost-containment efforts
–Shift from acute services to preventive

  • Counterforces to collaboration

–Safety net
–Dumping of services
–Coordination of state reporting
–Nature of for-profit firms

  • Economics of alternative therapies
  • Significance of Economics for Community Health Nursing Practice
  • Disease prevention/health promotion
  • Consumer-driven health care
  • Nurses can help consumers understand price and quality issues
  • Gaining third-party reimbursement—an important labor market change for nurses
  • Coalition building, research, lobbying, negotiating with insurers, influencing policymaking
  • Economics and Nightingale’s Legacy
  • Market justice
  • Social justice
  • Community Nursing – Discussion Questions
  • Chapter 13
    Environmental Health
  • Trends in Exposure and Disease
  • World view

–Health risks from environmental toxicants
–Rapid increase in the world’s population
–Changes in urbanization and agricultural production
–Recent ecological changes

  • Population movement
  • Deforestation
  • Irrigation
  • Expanding urbanization
  • Change in agricultural practices
  • Environmental Health
  • Definition: freedom from illness or injury related to toxic agents and other environmental conditions

–Applications range from hospital rooms to international and global perspectives on health of the planet

  • Environmental Health Policy: Historical Perspectives
  • Early environmental health focused on sanitation, water quality, and housing

–Mortality rates decreased

  • Influential publication:

–Carson, R. (1962). Silent spring. Boston: Houghton Mifflin

  • Legislation and commissions

–Clean air and water acts
–Occupational health
–Safety acts
–Pollution Prevention Act of 1990
–Toxic Substances Control Act
–Environmental Protection Agency
–Occupational Safety and Health Administration Nuclear Regulation Commission

  • Recent Health Issues & Trends
  • Issues

–Damage to the environment
–Population growth
–Urban spread
–Advanced technology
–Modern agricultural methods

  • Trends

–Focus on the built environment
–Children’s environmental health

  • Chemicals, pesticides, mercury, smoke

–Environmental justice movement

  • Historical Perspectives on Environment and Health
  • Epidemiology


  • Chronic disease epidemiology

–Asbestos and mesothelioma
–Prenatal exposure to diethylstilbestrol (DES)
–Occupational exposure

  • Origins of Environmental Health Policy
  • Industrial Revolution—1800s

–Focus on modernization and rapid production of goods and services
–Growing concern for working conditions and safety of workers

  • 1900s

–Environmental health and safety
–Passages of laws to protect the public
–Pure Food and Drug Law
–Food and Drug Administration

  • 1960s–1970s

–Post-war industrial rebuilding
–Consumer-driven environmental movement

  • Environmental Policy: Governmental Roles
  • Protect and safeguard
  • Pass laws and enact rules and regulations
  • Identify and monitor risks and hazards

Healthy People 2020

  • Monitor compliance with rules
  • Gather data to inform policymakers
  • Nursing and the Environment
  • Nightingale

–Pure, fresh air
–Pure water
–Efficient drainage

  • Emerging Role

–Intervene directly in environmental factors

  • Role of the Community Health Nurse
  • Identify risks
  • Assess exposures
  • Communicate risks
  • Assess and refer clients
  • “Upstream Thinking”
  • Ethical Principles

–Social justice
–Environmental justice

Community Nursing – Discussion Questions

  • Chapter 9
    Politics and the Law
  • Government Authority
  • Protection of the public’s health

–U.S. Constitution
–Bill of Rights
–State power

  • Power, Authority, and the
    Health of the Public
  • Concepts of power


  • Evolution of the Government’s
    Role in Health Care
  • Preamble of the U.S Constitution

–“Promote the general welfare” of the people

  • Marine Hospital Service
  • The Shattuck Report
  • Hill-Burton Act
  • Evolution of the Government’s
    Role in Health Care (cont.)
  • Medicare & Medicaid
  • The Civil Rights Act of 1964
  • National Environmental Policy Act
  • Americans with Disabilities Act (ADA)
  • Affordable Care Act (ACA) of 2010
  • Federal Government

–Office of the President
–Federal Court System

  • U.S. Public Health Agencies
  • National Institutes of Health
  • Food and Drug Administration
  • Centers for Disease Control and Prevention
  • Indian Health Service
  • Health Resources and Services Administration
  • Substance Abuse and Mental Health Services Administration
  • Agency for Healthcare Research and Quality
  • U.S. Public Health Service Corps
  • Human Services Agencies
  • Centers for Medicare and Medicaid Services
  • Administration for Children and Families
  • Administration on Aging
  • Department of Education
  • Department of Labor
  • Legislative Branch
  • U.S. Congress

–Has two houses with equal power:

  • Senate
  • House of Representatives
  • Judicial Branch
  • 94 federal districts courts
  • 12 circuit courts of appeals
  • U.S. Supreme Court
  • Several specialized courts
  • State Government
  • Executive
  • Legislative
  • Judicial
  • Local Government
  • Public health
  • Public education
  • Drinking water
  • Sewage disposal
  • Police protection
  • Solid waste management
  • Different Types of Law
  • Constitutional law
  • Statutory law
  • Judicial or common law

–Civil or criminal

  • Regulation of Nursing Practice
  • Nurse practice acts of each state control:

–Requirements for entry into practice
–Standards for acceptable practice
–Standards for continuing competence
–Disciplinary actions

  • Board of Nursing
  • Licensure of Nursing Practice
  • National Council Licensing Examination for Registered Nurses (NCLEX-RN)
  • Nursing Practice and Law
  • Negligence and malpractice
  • Correctional settings
  • Forensic nursing
  • Chapter9   Chapter13   Chapter81

Community Nursing – Discussion Questions

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