Which of the following was promoted as an alternative for fee-for-service and employs the tightest utilization controls?
Health Maintenance Organization (HMO)
Medicare Advantage (Part C)
Preferred Provider Organization (PPO)
Point of Service (POS)
The Correct Answer is A
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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Beliefs and values of Americans: While public opinion and support may influence the fate of healthcare policies, the survival of the Affordable Care Act (ACA) has been significantly
impacted by legal challenges and court rulings.
B. Moderation of health care costs: While controlling healthcare costs is an important goal of the ACA, it has not been the primary factor ensuring its survival.
C. Court rulings: Legal challenges to various aspects of the ACA, including its constitutionality and implementation, have led to significant court rulings that have shaped and determined its survival.
D. Political maneuvering: Political factors and maneuvering have certainly played a role in debates and attempts to repeal or modify the ACA, but court rulings have been more directly influential in determining its survival.
Correct Answer is B
Explanation
Rationale:
A. Cost cutting: While cost containment measures are important in healthcare, they are not necessarily a foreseeable trend in the future of health services delivery. Trends may involve cost containment strategies, but they are not the overarching trend.
B. Demographics: Changes in demographics, such as an aging population or shifts in population distribution, are significant factors that will influence the future of health services delivery. These changes can impact healthcare needs, resource allocation, and service delivery models.
C. Quicker discharge of patients: While there may be efforts to improve efficiency in healthcare delivery, such as reducing hospital lengths of stay, this is not necessarily a widespread trend or a defining characteristic of the future of health services delivery.
D. Level of education of healthcare personnel: The level of education of healthcare personnel may evolve over time, but it is not necessarily a trend that defines the future of health services delivery.
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