A client states that she does not understand managed care ...

[rlane42]

A client states that she does not understand managed care organization (MCO) health insurance. The nurse responds most appropriately by explaining that the MCO:
 
  1. Reimburses nursing home funding
  2. Focuses on health maintenance and primary care
  3. Allows the individual to go to any physician that he desires
  4. Requires a contractual agreement between the health provider and client's em-ployer

Question 2

A disabled client requiring restorative care should be referred to a(n):
 
  1. Nursing home
  2. Subacute care unit
  3. Home health care agency
  4. Ambulatory health center

[katara]

Answer to Question 1

ANS: 2
In a managed care organization (MCO), a primary care physician provides all care and the focus is on health maintenance and primary care.
Medicaid reimburses nursing home funding.
In a managed care organization, referral by the primary care physician is necessary for access to specialists and for hospitalization.
A PPO is limited to a contractual agreement between a set of providers and one or more pur-chasers.

Answer to Question 2

ANS: 3
A home health care agency provides health services to individuals and families in their home to promote, maintain, or restore health, or to maximize the level of independence while minimizing the effects of disability and illness.
A nursing home is a long-term care setting in which clients receive 24-hour intermediate and custodial care.
A subacute care unit is not the best referral for restorative care.
An ambulatory health center is not the best referral for restorative care.

[rlane42]

TYSM

[Joy Chen]

Gracias!