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問題 #109
What is the difference between a deductible and a self-insured retention?
答案：C
解題說明：
According to Health Care Risk Management principles outlined by ASHRM and the American Hospital Association Certification Center, both deductibles and self-insured retentions are mechanisms used in risk financing to allocate a portion of loss to the insured organization. However, they function differently in relation to the insurer's obligation.
A deductible is typically subtracted from the amount paid by the commercial carrier. In many policies, the insurer may pay the full claim amount and then seek reimbursement of the deductible from the insured, or the insured may pay the deductible portion while the insurer handles defense and indemnity payments above that amount. The key distinction is that coverage attaches immediately, but the insured ultimately bears the deductible portion.
A self-insured retention differs in that the insured must satisfy the retention amount before the insurer's coverage is triggered. Until the retention is exhausted, the insured is responsible for payment and often for defense management.
Option B incorrectly describes a deductible as operating like a self-insured retention. Option C does not distinguish between the two mechanisms. Option D is incorrect because self-insured retention applies before, not after, carrier limits.
Therefore, the correct distinction is that a deductible is subtracted from amounts paid by the commercial carrier.
問題 #110
A hospital risk manager has been called to the Neonatal Intensive Care Unit to discuss a 25-week premature infant whose parents are refusing a planned blood transfusion due to their religious beliefs. After gathering information on the infant's condition and hearing the parents and the healthcare professionals disagree on the best interests of the infant, the risk manager should
答案：A
解題說明：
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, while parents generally serve as surrogate decision-makers for minors, their authority is not absolute. When refusal of treatment places a child at significant risk of serious harm or death, healthcare providers have an ethical and legal obligation to act in the best interests of the child.
In cases involving life-sustaining treatment for a premature infant, refusal of a medically necessary blood transfusion may constitute potential medical neglect if it threatens the infant's survival. When disagreement persists after appropriate communication and ethics consultation, and the infant's life is at risk, the appropriate step is to seek judicial intervention. Contacting legal counsel to obtain an emergency court order allows the state to exercise its parens patriae authority to protect the child's welfare.
An ethics consultation may help clarify values and promote dialogue but does not override urgent medical necessity. Simply prohibiting or proceeding without legal authority exposes the organization to liability.
Legal and regulatory objectives emphasize protecting vulnerable patients while respecting due process.
Therefore, seeking an emergency court order through legal counsel is the appropriate action.
問題 #111
What is responsible for many HIPAA privacy violations in practice?
答案：B
解題說明：
A frequent HIPAA Privacy Rule violation isimpermissible access or disclosureof protected health information-commonly including employee "snooping" (accessing records of family, friends, coworkers, or celebrities without a work-related need) and other unauthorized disclosures. Risk management objectives focus on preventing these events through role-based access, audit logs with active monitoring, sanctions policies consistently enforced, workforce training, and a culture that treats privacy as patient safety. Even when disclosures are not malicious, "minimum necessary" failures, misdirected faxes/emails, and unsecured devices can create reportable breaches. Effective prevention is layered: technical controls (access restrictions), administrative controls (policies, training), and detection/response (auditing, rapid mitigation). Privacy violations are high-risk because they harm patients, trigger regulatory action, and damage trust and reputation.
問題 #112
If there is no OSHA standard for a given potential health hazard, OSHA may:
答案：A
解題說明：
OSHA can cite employers under theGeneral Duty Clausewhen a recognized serious hazard exists and no specific standard applies. Risk management objectives require proactive hazard identification and controls even when regulations are not prescriptive: risk assessments, engineering controls where feasible, administrative controls (policies, training), and PPE as a final layer. In healthcare, this is relevant for emerging hazards (novel chemical exposures, workplace violence risks, certain ergonomic hazards) where specific standards may be limited. Maintaining documentation of hazard recognition and mitigation is essential for defensibility during inspections and for staff safety outcomes.
問題 #113
A patient who has suffered a stroke is aphasic and unable to swallow. The physician would like to place a PEG tube for feeding. The patient is considered incapacitated and his wife consents to the treatment. The patient's adult children do not. The wife and oldest daughter each present a power of attorney document identifying them as the designated decision makers. To support the ethical principle of patient autonomy, which of the following should the risk manager recommend?
答案：D
解題說明：
Under Health Care Risk Management principles supported by ASHRM and the American Hospital Association Certification Center, patient autonomy is upheld by honoring valid advance directives and durable powers of attorney for healthcare. When multiple documents are presented that designate different decision makers, the most recent properly executed document typically supersedes earlier versions, unless state law provides otherwise.
Durable powers of attorney for healthcare may be revoked or replaced by executing a newer document.
Therefore, determining the effective document requires reviewing execution dates and ensuring validity under applicable state statutes, including witnessing and notarization requirements. The document with the more recent date generally reflects the patient's latest expressed wishes and controls decision-making authority.
Referring immediately to an ethics committee may be appropriate in unresolved value conflicts, but first establishing legal authority is essential. Asking the family to resolve the dispute independently delays necessary medical decisions and does not clarify legal standing. Selecting the older document would contradict the principle that later directives replace earlier ones.
Legal and regulatory objectives emphasize verification of surrogate authority, compliance with state advance directive laws, and protection of patient autonomy. Therefore, the risk manager should confirm which document is most recent and legally valid.
問題 #114
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