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 D
Explanation
Rationale:
A. Private businesses: While private businesses play a significant role in healthcare delivery, they are not the single most dominant force.
B. Higher levels of services: This option is vague and does not specifically identify a dominant force in healthcare delivery.
C. Virtual organizations: Virtual organizations may be an emerging trend in healthcare delivery, but they are not currently the single most dominant force.
D. Managed care: Managed care, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and accountable care organizations (ACOs), has significantly
influenced healthcare delivery in the United States by emphasizing cost containment, quality
improvement, and coordination of care. As such, it is considered the single most dominant force in U.S. healthcare delivery.
Correct Answer is D
Explanation
A. Health insurance companies: While health insurance companies may play a role in administering Medicare plans, they do not directly pay for the benefits of Medicare. Medicare is primarily funded through taxpayer contributions.
B. Only doctors and nurses: Healthcare providers, including doctors and nurses, do not directly pay for the benefits of Medicare. They may receive reimbursements for services rendered to Medicare beneficiaries, but they are not the ones funding the program.
C. Hospital employees: Hospital employees do not directly pay for the benefits of Medicare.
Like other taxpayers, they may contribute to Medicare funding through taxes deducted from their salaries.
D. Taxpayers: The benefits of Medicare, a federal health insurance program primarily for people age 65 and older, are funded by taxpayers through various revenue sources, including payroll
taxes, income taxes, and premiums paid by beneficiaries.
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