What is one reason that cost-control efforts in the United States have not been successful?
Wastage at clinics
Global healthcare issues
Poor patient outcomes
Cost shifting
The Correct Answer is D
Rationale:
A. Wastage at clinics: While wastage at clinics may contribute to inefficiencies in the healthcare system, it is not a primary reason that cost-control efforts in the United States have not been successful.
B. Global healthcare issues: While global healthcare issues may impact the broader context of healthcare delivery, they are not a specific reason for the lack of success in cost-control efforts within the United States.
C. Poor patient outcomes: Poor patient outcomes may contribute to healthcare costs, but they are not the primary reason that cost-control efforts have not been successful.
D. Cost shifting: Cost shifting refers to the practice of shifting costs from one payer to another, such as from private insurers to public payers like Medicare and Medicaid. This practice can undermine efforts to control costs by redistributing financial burdens rather than addressing underlying cost drivers.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. By integration of several organizations under the same ownership or contractual
arrangements: MCOs garner enormous buying power by integrating various healthcare providers and services under one ownership or through contractual agreements, which allows them to negotiate better rates with suppliers and providers.
B. By shared savings program under the ACA: While the shared savings program under the ACA aims to reduce healthcare costs, it is not the primary method through which MCOs gained their buying power.
C. By providing an array of health care services to a large community: Providing a wide range of services enhances the value offered by MCOs but does not directly lead to significant buying power.
D. By enrolling a large segment of the insured population: Enrolling a large number of insured
individuals helps MCOs spread risk but is not the main factor that provides them with enormous buying power.
Correct Answer is A
Explanation
Rationale:
A. Health Maintenance Organization (HMO): HMOs were promoted as an alternative to
traditional fee-for-service models and typically employ stringent utilization controls, such as requiring members to select a primary care physician (PCP) and obtain referrals for specialist care.
B. Medicare Advantage (Part C): Medicare Advantage plans, while offering alternatives to
traditional Medicare fee-for-service, may not necessarily employ the tightest utilization controls compared to HMOs.
C. Preferred Provider Organization (PPO): PPOs offer more flexibility in choosing healthcare providers and typically have less stringent utilization controls compared to HMOs.
D. Point of Service (POS): POS plans combine elements of HMOs and PPOs, allowing members to choose between in-network and out-of-network care, but may not have as tight utilization controls as pure HMOs.
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