Question 1

Most empirical studies show that the cost-savings provided by managed care are accomplished by
a. better preventive care.
b. reducing the rate of hospitalization.
c. denying access to costly specialty care.
d. switching to generic drugs.
e. all of the above.

reducing the rate of hospitalization.

Accepted Answer

Managed care often reduces costs by decreasing the rate of hospitalization through better management of patient care and coordination, rather than primarily focusing on preventive care, denying specialty care, or switching to generic drugs.

Question 2

Kaiser-Permanente, the nation's largest health maintenance organization, was founded
a. to provide cost-effective medical care to Kaiser employees.
b. to provide access to medical care to Kaiser workers in remote locations where medical services were in short supply.
c. to slow the rate of growth in medical spending for Kaiser employees.
d. as a group-model HMO.
e. as a network-model HMO.

Accepted Answer

Kaiser-Permanente was originally founded to provide access to medical care for Kaiser workers in remote locations, such as construction sites, where medical services were scarce.

Question 3

Capitation&#10;a. creates pressures to provide fewer services.&#10;b. is a fixed payment determined in advance to pay for all medically-necessary care.&#10;c. is the maximum allowable fee in a fee-for-service system.&#10;d. shifts financial risk onto patients.&#10;e. Both a and b are correct.

Accepted Answer

Capitation involves a fixed payment determined in advance to cover all necessary medical care, creating pressure to provide fewer services to manage costs effectively.

Question 4

The health maintenance organization where the physicians are salaried employees of the HMO is called
a. a group-model HMO.
b. a staff-model HMO.
c. a network-model HMO.
d. an IPA.
e. a direct-contract HMO.

Accepted Answer

In a staff-model HMO, physicians are salaried employees of the HMO and provide care exclusively for HMO members.

Question 5

The RAND Health Insurance experiment compared costs of HMOs with the costs of indemnity insurers. The study
a. confirmed the cost-saving potential of HMOs.
b. Found no cost-saving by HMOs.
c. the HMO had per capita costs that were 28% lower than the indemnity
d. both a and c

Accepted Answer

The RAND Health Insurance experiment found that HMOs had per capita costs that were 28% lower than indemnity insurers, confirming the cost-saving potential of HMOs.

Question 6

Network model HMOs use _______ to shift financial risk back onto providers.&#10;a. capitation.&#10;b. practice guidelines.&#10;c. open panels.&#10;d. closed panels.&#10;e. formularies.

Accepted Answer

Capitation is a payment arrangement where providers are paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care. This shifts financial risk to providers as they must manage the cost of care within the fixed payment.

Question 7

Which of the following statements is not true about managed care?
a. Empirical evidence suggests that managed care can reduce health care spending.
b. Most of managed care's savings can be traced to reduced hospitalization.
c. There is more emphasis on preventive care in managed care.
d. There is no credible evidence to suggest lower quality of care for any group of patients in managed care arrangements.

Accepted Answer

There is some evidence suggesting that managed care can lead to lower quality of care for certain groups of patients, particularly those with complex or chronic conditions, due to cost-cutting measures and restrictions on services.

Question 8

Managed care&#10;a. establishes a system of retrospective payment determined ex ante.&#10;b. combines the responsibilities of payer and provider of medical services.&#10;c. attempts to shift a portion of the financial risk onto providers.&#10;d. attempts to shift a portion of the financial risk onto patients.&#10;e. Both b and c are correct.

Accepted Answer

Managed care combines the responsibilities of payer and provider of medical services and attempts to shift a portion of the financial risk onto providers.

Question 9

To control moral hazard and the increased spending that accompanies it, managed care providers include _______ in contracts with providers.
a. clinical rules
b. capitation
c. risk sharing
d. all of the above

Accepted Answer

Managed care providers include clinical rules, capitation, and risk sharing in contracts with providers to control moral hazard and the increased spending that accompanies it.

Question 10

The most important aspect of the change from fee-for-service to capitation is that
a. physicians get their money quicker.
b. patients get faster service since physicians don't have to worry about getting paid.
c. physicians make less money.
d. the most valuable patient is no longer the sickest, but the most healthy.

Accepted Answer

Under capitation, physicians receive a set amount per patient regardless of the number of services provided, making healthier patients more valuable as they require fewer resources.

Question 11

The health maintenance organization that contracts with individual physicians or group practices to provide care for a specified group of enrollees is called
a. a group-model HMO.
b. a staff-model HMO.
c. a network-model HMO.
d. an IPA.
e. a direct-contract HMO.

Accepted Answer

The answer of The health maintenance organization that contracts with...

Question 12

What is the motivation behind the cost-control features of managed care?
a. To ensure access to specialty care through general practitioner gatekeepers.
b. To influence the way physicians practice medicine by changing the financial incentive structure of medical care delivery.
c. to shift the financial risk onto patients.
d. to eliminate all the guesswork from diagnoses by establishing practice guidelines.
e. to create competition by providing patients with a wide range of providers.

Accepted Answer

The answer of What is the motivation behind the cost-control...

Question 13

Which type of managed care organization has the strictest cost control features?&#10;a. Group-model HMO.&#10;b. IPA.&#10;c. POS plan.&#10;d. Closed-panel HMO.&#10;e. PPO.

Accepted Answer

The answer of Which type of managed care organization has...

Deck 8: Managed Care