Health care test 4 – Flashcards
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The managed care phenomenon was welcomed mostly by
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A. Employers
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With the growth of managed care, the balance of power in the medical marketplace swung toward
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C. The demand side
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A managed care organization functions like
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B. An insurer
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What is the purpose of risk sharing with providers?
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B. It makes providers cost conscious
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Capitation is best describes as
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C. Per member per month payment
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Under capitation, risk is shifted
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D. From the MCO to the provider
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Under which payment method is a fee schedule used?
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C. Discounted fees
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The HMO act of 1973 required
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D. Employers to offer an HMO alternative to conventional health insurance
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In the term, managed care, "manage" refers to
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A. Management of utilization
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Under the fee-for-service system, providers had the incentive to
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A. Deliver more services than what would be medically necessary because a greater volume would increase their incomes
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Closed-panel plan
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D. The enrollee is restricted to the providers on the panel
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Gate keeping heavily depends on the services of a
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A. Primary care physician
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Gatekeeping emphasizes
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C. Preventive and primary care
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Under ____ a primary care physician becomes the portal of entry to the health care delivery system
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C. Gatekeeping
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Cost-effective management of care for patients who have complex medical conditions
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A. Case management
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A primary care physician decides whether or not to refer a patient to a specialist.
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B. Prospective utilization review
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Precertification is the responsibility of
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C. The health plan
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Under prospective utilization review, if a case is determined to be potentially complex and costly, it is referred to
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A. Case management
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Concurrent utilization review in a hospital will be primarily concerned with the
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B. Length of stay
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Closely associated with concurrent utilization review is the function of
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D. Discharge planning
