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 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 healthcare insurance program.
The provider is paid a fixed sum for the client on a monthly or yearly basis.
The Correct Answer is D
In a health maintenance organization (HMO), the provider is paid a set amount of money for each client enrolled in the program. This payment structure is known as capitation.
The provider is responsible for providing all necessary healthcare services to the client within the confines of the capitated payment.
The client is not required to pay the provider directly for any services rendered within the HMO network.
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Related Questions
Correct Answer is D
Explanation
Many migrants may not speak the language of the country they are in, which can create significant barriers to accessing health care. Therefore, it is crucial for the nurse to ensure access to interpretation services, such as hiring bilingual staff or interpreters, or using telephone interpretation services.
Treating illnesses on a fee-for-service basis may be a barrier to accessing care for migrants who may not have insurance or the financial resources to pay for services.
Providing health services at work sites may be helpful, but it may not reach all members of the migrant population.
Offering health screenings at a community center may be helpful, but it may not address the issue of language barriers.
Correct Answer is D
Explanation
Bending at the waist to lift heavy objects can increase the risk of back injury, even when wearing a back brace. The nurse should advise this worker to bend at the knees and keep the back straight when lifting heavy objects. The worker who is standing with a wide base of support when pulling a cart toward himself is using proper body mechanics, which helps reduce the risk of injury.
The worker who is 7-weeks postoperative following rotator cuff surgery and is labeling boxes should avoid lifting heavy objects or performing tasks that require excessive use of the affected arm. The worker who is standing in place for extended periods and rests one foot on a box may experience fatigue or discomfort, but is not necessarily at an increased risk for injury.
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