What Is Managed Care?
Has an organized physician staff
Managed care is a mechanism of providing health care services
An institution with at least six beds and that delivers diagnostic and therapeutic services for medical conditions
Provide continuous nursing service under RNS
The Correct Answer is B
Rationale:
A. Has an organized physician staff: This describes one characteristic of managed care organizations (MCOs), but it does not fully define managed care itself.
B. Managed care is a mechanism of providing health care services: Managed care refers to a system or approach to healthcare delivery that aims to manage and coordinate healthcare services
to improve quality, control costs, and optimize outcomes. It involves mechanisms such as provider networks, utilization management, and financial incentives to achieve these goals.
C. An institution with at least six beds and that delivers diagnostic and therapeutic services for medical conditions: This describes a hospital rather than managed care.
D. Provide continuous nursing service under RNS: This describes a specific nursing service and is not a comprehensive definition of managed care.
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Related Questions
Correct Answer is D
Explanation
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.
Correct Answer is C
Explanation
Rationale:
A. Promotes the use of performance measurements in health care: This answer describes the purpose of quality indicators in general but does not specifically address the macro perspective.
B. Focus on individual services at the point of delivery: This describes the micro perspective, which focuses on specific aspects of care delivery.
C. Reflect the performance of the entire health care delivery system: The macro perspective of quality indicators looks at the overall performance of the entire healthcare system, including factors such as access, effectiveness, and efficiency.
D. Look at the performance of an individual or organization: While this may be a component of quality measurement, it does not encompass the broader view of the macro perspective.
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