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: People who have substance use disorders are not the fastest growing segment of the homeless population, although they are a significant and vulnerable group. Substance use disorders may contribute to or result from homelessness, but they are not the primary cause of the increase in homelessness.
Choice B reason: Families who have children are the fastest growing segment of the homeless population, according to the U.S. Department of Housing and Urban Development (HUD). The number of homeless families with children increased by 9% from 2019 to 2020, and they accounted for 34% of the total homeless population in 2020. The main causes of family homelessness are lack of affordable housing, poverty, unemployment, domestic violence, and health problems.
Choice C reason: Adolescent runaways are not the fastest growing segment of the homeless population, although they are a high-risk and underserved group. Adolescent runaways may face challenges such as abuse, exploitation, mental health issues, and lack of education and employment opportunities. However, the number of homeless youth is difficult to estimate due to their hidden and transient nature.
Choice D reason: Men who are unemployed are not the fastest growing segment of the homeless population, although they are a large and diverse group. Men who are unemployed may face barriers such as low wages, lack of skills, discrimination, and health problems. However, the number of homeless men has decreased by 5% from 2019 to 2020, and they accounted for 60% of the total homeless population in 2020.
Correct Answer is C
Explanation
Choice A reason: The client dressing her affected side first is not a finding that the nurse should report to the interprofessional care team, as it indicates that the client is following the proper technique for dressing after a stroke. Dressing the affected side first helps the client maintain range of motion and prevent contractures of the affected limbs.
Choice B reason: The client bearing weight on their arms when using crutches is not a finding that the nurse should report to the interprofessional care team, as it is a normal and expected way of using crutches. Bearing weight on the arms helps the client balance and support their body weight while walking with crutches.
Choice C reason: The client coughing when swallowing her medications is a finding that the nurse should report to the interprofessional care team, as it indicates that the client may have dysphagia, or difficulty swallowing, which is a common complication of stroke. Dysphagia can increase the risk of aspiration, pneumonia, dehydration, and malnutrition. The nurse should assess the client's swallowing ability and refer them to a speech-language pathologist for further evaluation and intervention.
Choice D reason: The client's caregiver filling a pill organizer weekly is not a finding that the nurse should report to the interprofessional care team, as it is a positive and helpful way of managing the client's medications. Filling a pill organizer weekly can help the client and the caregiver remember the medication names, doses, and schedules, and prevent medication errors or omissions.
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