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 bills the client directly for a predetermined percentage of the cost of services.
The provider is paid a fixed sum for the client on a monthly or yearly basis.
The client is participating in a fee-for-service health care insurance program.
The client pays the insurer a percentage of the total costs for each service rendered by the provider.
The Correct Answer is B
Answer is b. The provider is paid a fixed sum for the client on a monthly or yearly basis.
A health maintenance organization (HMO) is a type of health insurance that contracts with a network of providers and facilities to offer care at a discounted rate. The HMO pays the provider a fixed sum for each client, regardless of the services they use. This is called capitation³. The HMO also requires the client to have a primary care provider who coordinates their care and makes referrals to specialists².
a. This statement is wrong because it describes a co-payment, which is a fixed amount that the client pays for each service. Co-payments are usually low in HMOs, but they are not the main payment structure².
c. This statement is wrong because it describes a fee-for-service health care insurance program, which is the opposite of an HMO. In a fee-for-service program, the client pays the insurer for each service they use, and the insurer reimburses the provider. This gives the client more freedom to choose their provider, but it also increases the cost of health care¹.
d. This statement is wrong because it describes a co-insurance, which is a percentage of the total cost that the client pays for each service. Co-insurance is more common in preferred provider organizations (PPOs), which are another type of health insurance that offer more flexibility than HMOs, but also higher premiums
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Correct Answer is B
Explanation
The correct answer is choice B. When caring for clients from different cultural backgrounds, it is important to be respectful and non-judgmental. In this situation, the nurse should ask the family to describe how they hope the treatments will affect their health. This will allow the nurse to gain a better understanding of the family's beliefs and values regarding health and illness. The nurse should avoid making assumptions or judgments about the family's beliefs and should not criticize or dismiss the folk healer. Alternative medicine practices (choice A) can be dangerous in some cases, but it is not appropriate to make a blanket statement that they should be avoided. Suggesting that folk medicine works by providing a placebo effect (choice C) is not respectful of the family's beliefs and is dismissive of their cultural practices. Referring the family to a medical practitioner (choice D) may not be appropriate if the family has a strong belief in folk medicine practices.
Correct Answer is C
Explanation
. Autonomy. Autonomy is the ethical principle that upholds a patient's right to make their own healthcare decisions. In this scenario, the nurse acknowledges the patient's right to refuse treatment and informs them that they will support their decision. By doing so, the nurse is respecting the patient's autonomy and their right to make decisions about their own body and treatment.
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