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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Related Questions
Correct Answer is B
Explanation
Rationale:
A. The United Kingdom: The United Kingdom has a publicly funded healthcare system
(National Health Service), which typically has lower healthcare costs compared to the United States.
B. The United States: The United States consistently has the highest healthcare costs per capita among developed countries due to factors such as high administrative costs, pharmaceutical prices, and utilization rates.
C. Canada: Canada has a publicly funded healthcare system (Medicare), which generally has lower healthcare costs compared to the United States.
D. Jamaica: Jamaica's healthcare system is characterized by resource constraints, and healthcare costs are typically lower compared to those in the United States.
Correct Answer is D
Explanation
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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