Research shows that issues with access to both primary care and specialty care prevail in:
Preferred Provider Organization (PPO) plan
Medicare advantage plans.
Medicaid managed care.
Health Maintenance Organization (HMO) plans
The Correct Answer is D
Rationale:
A. Preferred Provider Organization (PPO) plan: PPO plans typically offer members greater flexibility in choosing healthcare providers and may not have as strict requirements for referrals to specialists, reducing barriers to access.
B. Medicare advantage plans: Medicare Advantage plans, also known as Medicare Part C, offer additional benefits beyond traditional Medicare, but they may not exhibit the same issues with access to primary and specialty care as other managed care plans.
C. Medicaid managed care: Medicaid managed care plans vary by state and may have different structures for accessing care, but they often emphasize primary care coordination and may not exhibit the same issues with access as HMO plans.
D. Health Maintenance Organization (HMO) plans: HMO plans typically require members to select a primary care physician (PCP) and obtain referrals from the PCP to see specialists. This structure can create barriers to accessing specialty care, particularly if there are limitations in provider networks or delays in obtaining referrals.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Secondary care: Secondary care refers to specialized healthcare services provided by medical specialists upon referral from primary care providers. It typically involves services such as diagnosis, treatment, and management of specific health conditions.
B. Primary care: Primary care involves general healthcare services provided by healthcare professionals such as physicians, nurse practitioners, and physician assistants. It focuses on preventive care, health maintenance, and initial diagnosis and treatment of common health problems.
C. Hospice care: Hospice care is a type of end-of-life care provided to individuals with terminal illnesses or conditions. It focuses on enhancing quality of life and providing comfort, support, and symptom management for patients and their families during the final stages of life.
D. Tertiary care: Tertiary care refers to highly specialized medical care provided by specialized hospitals, medical centers, or specialty clinics. It involves complex procedures, treatments, and interventions for patients with serious or complex health conditions.
Correct Answer is D
Explanation
Rationale:
A. Technology: While technological advancements may have influenced healthcare delivery, they did not directly trigger hospital downsizing in the 1980s.
B. Hill-Burton Act (1946): The Hill-Burton Act provided federal funding for hospital construction and modernization, which typically led to expansion rather than downsizing of hospitals.
C. Covid-19: Covid-19 emerged long after the 1980s and is not related to the hospital downsizing trends of that decade.
D. Prospective Payment System (PPS): The implementation of the Prospective Payment System (PPS) in the 1980s, particularly for Medicare reimbursements, shifted hospital reimbursement from fee-for-service to a predetermined payment based on diagnosis-related groups (DRGs).
This change incentivized hospitals to become more efficient and led to downsizing, closure of underutilized facilities, and consolidation of services.
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