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N108: Transition to the Registered Professional Nurse Role Study Guide of 172 effective and beneficial forms of care for the largest number of persons. Without rationing, health- care costs in the U.S. may affect spending on every other important function of government and society. Health Maintenance Organizations (HMO) The first managed care organizations were HMOs, which originated as an alternative to traditional insurance plans and were nonprofit in nature. HMOs were the first to provide payment for care aimed at preventing illness. HMOs provided well-child care, prenatal care, immunizations, gynecological examinations, and other preventative services when insurance companies did not. Because the HMO receives the same income (except for modest co-payments), whether a client requires extensive care or very little care, there is a built-in incentive to emphasize preventative care and avoid costly hospitalization. A flat charge per month covers routine preventative healthcare including care for illness, hospitalization, and in some instances, prescription costs, outpatient care, and other services. It offers basic and supplemental health services to a consumer. Community Based Care A community based philosophy rests on a fundamental belief in the right of the client to control his or her life, including situations related to healthcare. Community based nursing refers to a wide variety of settings other than inpatient institutions in which nursing is practiced. Public health, home health, ambulatory care, occupational health, and school nursing all reflect community based practice. Care in the community is cost-effective and often more acceptable to the client because it causes less disruption in life. The principles of community based care include an emphasis on advocating for patients, prompting patient education and self-care, focusing on health promotion and disease prevention, and recognizing the importance of family, culture, and the community. Community based care requires effective communication and collaboration. The key in all of these community settings is that the client is in charge. The client decides to work with the nurse to accept or reject advice and suggestions, and to enter and leave care. The nurse serves as the educator, a guide, a resource person, and an advocate, but health action is taken by the client and the family. All nurses working in community based care services need to be aware of the community in which the client resides and be able to provide care that fits within the scope of the person’s life rather than simply an episode of an illness. Care must be family-centered and culturally competent. Nurses working in all environments must be aware of community health organizations, be knowledgeable about availability and accessibility to services and supplies, and be familiar with the location and specialty of healthcare providers. Examples of community based organizations include public health departments, community health centers that provide health care to patients who are uninsured or covered by Medicaid, and Federally Qualified Health Centers (FQHCs) who provide primary and preventive health care to more than 20 million people in all 50 states and U.S. territories. They receive federal funding through the Health Resources and Services Administration (HRSA). ©2018 Achieve Page 94