What three factors are critical in differentiating between the types of managed care organization (MCOs)?
CEO with responsibility for operations
Payment and risk-sharing
Organized physician staff
Choice of providers
Different ways of arranging services
Correct Answer : B,D,E
Rationale:
A. CEO with responsibility for operations: While the leadership structure may vary among different managed care organizations (MCOs), it is not one of the critical factors in differentiating between types of MCOs.
B. Payment and risk-sharing: Payment mechanisms and risk-sharing arrangements are crucial factors that differentiate between different types of MCOs, such as HMOs, PPOs, and POS plans.
C. Organized physician staff: While the organization of physician staff may vary among MCOs, it is not one of the critical factors in differentiating between types of MCOs.
D. Choice of providers: The availability of provider networks and the degree of member choice in selecting healthcare providers are important factors that differentiate between types of MCOs.
E. Different ways of arranging services: The methods by which healthcare services are arranged and delivered, such as through primary care gatekeepers or direct access to specialists, are critical factors that distinguish between different types of MCOs.
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Related Questions
Correct Answer is A
Explanation
A. A nonfederal short-stay hospital whose services are available to the general public: Community hospitals are defined as nonfederal short-stay hospitals that provide a range of services to the general public and are accessible to all members of the community.
B. Nongovernment and privately owned: While many community hospitals may be privately owned, this option does not encompass the full definition as it excludes government-owned hospitals that serve the community.
C. Government ownership (federal, state, or local): Community hospitals can be government- owned, but this answer does not capture the full scope of what defines a community hospital.
D. Often located in large urban areas: Community hospitals can be found in both urban and rural areas, so this answer is not sufficiently inclusive.
Correct Answer is B
Explanation
Rationale:
A. Chronic disease prevention and management: While chronic diseases can contribute to healthcare costs, they are not directly related to waste and abuse within the healthcare system.
B. Fraud: Fraudulent activities, such as billing for services not provided or submitting false
claims, contribute to waste and abuse in the healthcare system, leading to higher costs for payers and consumers.
C. Unequal access to health care: Unequal access to healthcare may lead to disparities in health outcomes and healthcare utilization but is not necessarily a direct cause of waste and abuse.
D. Competitive approaches: Competitive approaches may influence healthcare delivery models and pricing strategies but are not directly related to waste and abuse contributing to rising
healthcare costs.
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