Health care test 4

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