A nurse is working with a care manager for a client who participates in a health maintenance organization. The nurse should identify that a health maintenance organization provides which of the following payment structures?
The client is participating in a fee-for-service health care insurance program.
The provider is paid a fixed sum for the client on a monthly or yearly basis.
The client pays the insurer a percentage of the total costs for each service rendered by the provider.
The provider bills the client directly for a predetermined percentage of the cost of services.
The Correct Answer is B
Choice A reason: A fee-for-service health care insurance program is not a payment structure of a health maintenance organization. In a fee-for-service program, the client pays a premium to the insurer, and the insurer pays the provider for each service rendered, regardless of the outcome or quality of care.
Choice B reason: A fixed sum payment for the client on a monthly or yearly basis is a payment structure of a health maintenance organization. In this structure, the provider receives a set amount of money per client per period of time, regardless of the number or type of services provided. This encourages the provider to deliver preventive and primary care, and to avoid unnecessary or costly procedures.
Choice C reason: A percentage of the total costs for each service rendered by the provider is not a payment structure of a health maintenance organization. This is a type of cost-sharing arrangement, where the client pays a portion of the expenses and the insurer pays the rest. This may result in higher out-of-pocket costs for the client and higher utilization of services by the provider.
Choice D reason: A predetermined percentage of the cost of services is not a payment structure of a health maintenance organization. This is a type of discounted fee-for-service arrangement, where the provider agrees to accept a lower fee than the usual charge for each service. This may reduce the costs for the insurer, but not necessarily for the client or the provider.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Conducting counseling for at-risk parents is not a primary prevention strategy, as it is a secondary prevention strategy. Secondary prevention aims to stop violence from recurring after it happens, by identifying and intervening with those who are at risk of being victims or perpetrators of violence. Counseling for at-risk parents may help them cope with stress, resolve conflicts, and improve their relationships, but it does not prevent violence from happening in the first place.
Choice B reason: Assessing a family for marital discord is not a primary prevention strategy, as it is a secondary prevention strategy. Secondary prevention aims to stop violence from recurring after it happens, by identifying and intervening with those who are at risk of being victims or perpetrators of violence. Assessing a family for marital discord may help the nurse detect signs of abuse, neglect, or violence, and refer the family to appropriate services, but it does not prevent violence from happening in the first place.
Choice C reason: Teaching parenting techniques to new parents is a primary prevention strategy, as it aims to prevent violence from ever happening in the first place. Primary prevention works by addressing the underlying causes of violence, such as gender inequality, social norms, and power imbalances, and promoting positive attitudes and behaviors across the whole population. Teaching parenting techniques to new parents may help them develop skills, knowledge, and confidence to raise their children in a healthy, safe, and supportive environment, and prevent child abuse and neglect.
Choice D reason: Providing treatment for a young adult who has a substance use disorder is not a primary prevention strategy, as it is a tertiary prevention strategy. Tertiary prevention aims to respond to the long-term impacts of violence, by providing care and support to those who have experienced or perpetrated violence, and reducing the consequences and recurrence of violence. Providing treatment for a young adult who has a substance use disorder may help them recover from their addiction, improve their mental and physical health, and reduce their involvement in violence, but it does not prevent violence from happening in the first place.
Correct Answer is A
Explanation
Choice A reason:This is a correct recommendation. The American Academy of Ophthalmology advises adults aged 40–64 to have a comprehensive eye exam every 2 years. Regular exams are essential to detect common age-related conditions like glaucoma, cataracts, and macular degeneration. After age 65, annual eye exams are often recommended.
Choice B reason: You should have your hearing screened every 10 years, not every 5 years, until the age of 50. After 50, you should have a hearing test every 3 years.
Choice C reason:While stool-based testing for colorectal cancer (such as FOBT or FIT) is recommended starting at age 45, it is typically done annually, not every other year. Other screening methods, like a colonoscopy, may have a longer interval but should follow guidelines tailored to the patient’s risk profile.
Choice D reason: You should have your fasting blood glucose level checked every 3 years, not every 6 years, starting at age 45. This is a screening test for diabetes, which can increase your risk of heart disease, stroke, kidney disease, and other complications. If you have a history of gestational diabetes, obesity, or other risk factors, you may need more frequent testing.
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