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 B
Explanation
Choice A reason: Creating diversionary activities for children is not the priority action for the nurse to take. This is a supportive intervention that can help the children cope with the stress and trauma of the disaster, but it should be done after the nurse has ensured the safety and well-being of the clients.
Choice B reason: Addressing the physical needs of clients is the priority action for the nurse to take. This is based on the principle of Maslow's hierarchy of needs, which states that the nurse should prioritize the most basic and essential needs of the clients, such as food, water, shelter, clothing, and medical care. The nurse should assess the clients for any injuries, illnesses, or chronic conditions, and provide appropriate interventions or referrals.
Choice C reason: Helping clients gather needed supplies is not the priority action for the nurse to take. This is a helpful intervention that can assist the clients to obtain the resources and materials they need to survive and recover from the disaster, but it should be done after the nurse has addressed the physical needs of the clients.
Choice D reason: Exploring feelings the clients are experiencing is not the priority action for the nurse to take. This is a therapeutic intervention that can facilitate the emotional and psychological healing of the clients, but it should be done after the nurse has addressed the physical needs of the clients. The nurse should also respect the clients' readiness and willingness to share their feelings, and avoid forcing or rushing the process.
Correct Answer is C
Explanation
Choice A reason: Helping the client apply for Medicare is not the best action by the nurse, as Medicare is a federal health insurance program for people who are 65 or older, disabled, or have end-stage renal disease. The client does not meet any of these criteria and may not be eligible for Medicare.
Choice B reason: Exploring options for alternative therapies is not the best action by the nurse, as alternative therapies may not be effective or safe for treating tuberculosis. Tuberculosis is a serious bacterial infection that requires specific antibiotics to cure. Alternative therapies may also interfere with the prescribed medication or cause adverse effects.
Choice C reason: Arranging for medication through local agencies is the best action by the nurse, as it ensures that the client receives the appropriate treatment for tuberculosis. Local agencies may have programs or resources that can help the client access free or low-cost medication. The nurse should also educate the client about the importance of adhering to the medication regimen and completing the course of treatment.
Choice D reason: Sending the client to the nearest facility for further evaluation is not the best action by the nurse, as it may delay the initiation of treatment and increase the risk of transmission of tuberculosis to others. The client already has a diagnosis of tuberculosis and needs to start the treatment as soon as possible. The nurse should also advise the client to wear a mask and avoid close contact with others until the infection is no longer contagious.
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