A nurse is working with a case 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 provider is paid a fixed sum for the client on a monthly or yearly basis.
The provider bills the client directly for a predetermined percentage of the cost of services.
The client pays the insurer a percentage of the total costs for each service rendered by the provider.
The client is participating in a fee-for-service health care insurance program.
The Correct Answer is A
A. In a health maintenance organization (HMO), providers typically receive a fixed sum (capitation) for each client enrolled, regardless of the services provided.
B. Billing the client directly for services rendered is more typical of fee-for-service or cost-sharing arrangements.
C. This option describes a cost-sharing model where the client pays a portion of the service costs, common in some insurance plans but not HMOs.
D. Fee-for-service insurance involves providers billing for each service provided, not typical in HMOs where payments are typically fixed.
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Related Questions
Correct Answer is B
Explanation
A. Providing nutrition education is a form of primary prevention aimed at preventing the development of obesity-related health issues.
B. Screening for hearing loss in employees exposed to high levels of noise is a secondary prevention strategy, as it aims to detect and address health issues early to prevent further complications.
C. Providing education about safety and injury prevention is a primary prevention strategy designed to prevent injuries before they occur.
D. Coordinating disaster planning efforts is a preparedness measure and does not specifically fall under secondary prevention.
Correct Answer is A
Explanation
A. Establishing a triage area is the first step to manage and assess the situation systematically, ensuring that the most severe cases are identified and treated promptly.
B. Contacting the health department is important but not the first immediate action in a potential emergency.
C. Notifying parents is necessary but secondary to assessing and managing the students’ conditions.
D. Administering oxygen therapy may be necessary, but establishing a triage area allows the nurse to prioritize and manage resources effectively.
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