HMO Alternative to Conventional Health Insurance
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
HMO Alternative to Conventional Health Insurance
The managed care phenomenon was welcomed mostly bya. employersb.workersc.private insuranced.the gov
1)The managed care phenomenon was welcomed mostly bya.employersb.workersc.private insuranced.the government2) With the growth of managed care, the balance of power in the medical marketplace swung towarda.providersb.the supply sidec.the demand sided.more regulation3) A managed care organization functions likea.a providerb.an insurerc.a regulatord.a financier4) What is the purpose of risk sharing with providers?a.
It makes providers immune to costsb.It makes providers cost consciousc.It rewards providers for qualityd.It keeps insurance premiums low5)Capitation is best described asa.monthly lump sum payment regardless of utilizationb.monthly lump sum payment regardless of costc.per member per month paymentd.payments capped to a maximum cost for delivering services6)Under capitation, risk is shifteda.from the insured to the employerb.from the provider to the MCOc.from the employer to the MCOd.from the MCO to the provider7) Under which payment method is a fee schedule used?a.prospective paymentb.capitationc.discounted feesd.fee for service8)The HMO Act of 1973 requireda.health care providers to contract with HMOsb.managed care organizations to offer HMO alternativesc.insurers to switch to managed cared.employers to offer an HMO alternative to conventional health insurance9)In the term, managed care, ‘manage’ refers toa.management of utilizationb.
management of premiumsc.management of riskd.management of the supply of services10)Under the fee-for-service system, providers had the incentive toa.deliver more services than what would be medically necessary because a greater volume would increase their incomesb.use less technology because they could increase their incomes by not using costly proceduresc.indiscriminate cost increases because they could get paid whatever they would charged.increase the level of quality in order to attract more patients11)In the beginning, why did HMOs only had limited appeal?a.HMOs faced resistance from employers.
The shadow pricing practices used by HMOs were declared illegalc.The HMOs had only limited ability to control costs.d.The insured wanted to maintain the choice of providers12)Closed-panel plan.a.No new physicians can be added to the planb.New enrollees are not accepted by the planc.
The enrollee cannot switch from one plan to anotherd.The enrollee is restricted to the providers on the panel13)Gatekeeping heavily depends on the services of aa.primary care physicianb.case managerc.disease consultantd.nurse practitioner14)Gatekeeping emphasizesa.denial of specialized servicesb.closed-panel utilizationc.preventive and primary cared.secondary care15)Under _____ a primary care physician becomes the portal of entry to the health care delivery system.a.case managementb.utilization reviewc.gatekeepingd.closed-panel utilization16)Cost-effective management of care for patients who have complex medical conditions.a.Case managementb.Gatekeepingc.
RUBRIC
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