1. What is the primary goal of managed care?
a) To provide unlimited healthcare services
b) To manage the cost of healthcare
c) To centralize healthcare services
d) To deregulate the healthcare industry
Answer: b) To manage the cost of healthcare
Rationale: Managed care aims to control healthcare costs while
maintaining quality of care through various mechanisms such as network
selection, negotiated rates, and utilization review.
2. Which of the following is a key feature of Health Maintenance
Organizations (HMOs)?
a) Fee-for-service payment model
b) Out-of-network coverage
c) Gatekeeper model for specialist services
d) High-deductible health plans
Answer: c) Gatekeeper model for specialist services
Rationale: HMOs typically require a primary care physician to act as a
gatekeeper to specialist services, which helps to control costs and ensure
coordinated care.
3. What does capitation payment involve?
a) Providers are paid for each service rendered
b) Providers are paid a set amount for each enrolled person assigned to
them
c) Patients pay out-of-pocket for all healthcare services
d) Providers receive bonuses for high patient satisfaction scores
Answer: b) Providers are paid a set amount for each enrolled person
assigned to them
Rationale: Capitation is a payment arrangement where providers are
paid a set fee per patient regardless of how many services the patient uses,
incentivizing efficient care delivery.
4. Which entity is primarily responsible for accrediting managed care
organizations?
a) The Centers for Medicare & Medicaid Services (CMS)
b) The National Committee for Quality Assurance (NCQA)
c) The Joint Commission
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