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 B
Explanation
This action is appropriate because it allows the client to document their end-of-life wishes and ensure that they are honored.
Option A is incorrect because requesting the facility chaplain to visit the client is not directly related to the client's current health care needs.
Option C is incorrect because completing an against medical advice form is not appropriate in this situation, as the client has the right to refuse medical treatments, including enteral tube feedings.
Option D is incorrect because asking the client to sign an informed consent form is not necessary in this situation, as the client is not receiving a specific medical treatment that requires informed consent.
Correct Answer is A
Explanation
Pain expression is highly influenced by cultural background, and it is important for healthcare providers to understand how different cultures may express pain differently.
In Middle Eastern cultures, it is considered a sign of strength and stoicism to suppress pain and not show any outward signs of discomfort.
In contrast, Chinese culture views pain endurance as a virtue and a way to avoid bringing shame or dishonor to one's family.
Puerto Rican culture may view open expressions of pain as shameful, while Native American culture often views being outspoken about pain as a way of expressing oneself and communicating their needs to healthcare providers.
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