Chapter.8 Managed Care Test Bank

Chapter 8: Managed Care

Multiple Choice

1. Kaiser-Permanente, the nation’s largest health maintenance organization, was founded

1. to provide cost-effective medical care to Kaiser employees.
2. to provide access to medical care to Kaiser workers in remote locations where medical services were in short supply.
3. to slow the rate of growth in medical spending for Kaiser employees.
4. as a group-model HMO.
5. as a network-model HMO.

2. Managed care

1. establishes a system of retrospective payment determined ex ante.
2. combines the responsibilities of payer and provider of medical services.
3. attempts to shift a portion of the financial risk onto providers.
4. attempts to shift a portion of the financial risk onto patients.
5. Both b and c are correct.

3. Capitation

1. creates pressures to provide fewer services.
2. is a fixed payment determined in advance to pay for all medically-necessary care.
3. is the maximum allowable fee in a fee-for-service system.
4. shifts financial risk onto patients.
5. Both a and b are correct.

4. The health maintenance organization where the physicians are salaried employees of the HMO is called

1. a group-model HMO.
2. a staff-model HMO.
3. a network-model HMO.
4. an IPA.
5. a direct-contract HMO.

5. The health maintenance organization that contracts with individual physicians or group practices to provide care for a specified group of enrollees is called

1. a group-model HMO.
2. a staff-model HMO.
3. a network-model HMO.
4. an IPA.
5. a direct-contract HMO.

6. Network model HMOs use _______ to shift financial risk back onto providers.

1. capitation.
2. practice guidelines.
3. open panels.
4. closed panels.
5. formularies.

7. Which type of managed care organization has the strictest cost control features?

1. Group-model HMO.
2. IPA.
3. POS plan.
4. Closed-panel HMO.
5. PPO.

8. What is the motivation behind the cost-control features of managed care?

1. To ensure access to specialty care through general practitioner gatekeepers.
2. To influence the way physicians practice medicine by changing the financial incentive structure of medical care delivery.
3. to shift the financial risk onto patients.
4. to eliminate all the guesswork from diagnoses by establishing practice guidelines.
5. to create competition by providing patients with a wide range of providers.

9. The RAND Health Insurance experiment compared costs of HMOs with the costs of indemnity insurers. The study

1. confirmed the cost-saving potential of HMOs.
2. Found no cost-saving by HMOs.
3. the HMO had per capita costs that were 28% lower than the indemnity
4. both a and c

10. Most empirical studies show that the cost-savings provided by managed care are accomplished by

1. better preventive care.
2. reducing the rate of hospitalization.
3. denying access to costly specialty care.
4. switching to generic drugs.
5. all of the above.

11. To control moral hazard and the increased spending that accompanies it, managed care providers include _______ in contracts with providers.

1. clinical rules
2. capitation
3. risk sharing
4. all of the above

12. The most important aspect of the change from fee-for-service to capitation is that

1. physicians get their money quicker.
2. patients get faster service since physicians don’t have to worry about getting paid.
3. physicians make less money.
4. the most valuable patient is no longer the sickest, but the most healthy.

13. Which of the following statements is not true about managed care?

1. Empirical evidence suggests that managed care can reduce health care spending.
2. Most of managed care’s savings can be traced to reduced hospitalization.
3. There is more emphasis on preventive care in managed care.
4. There is no credible evidence to suggest lower quality of care for any group of patients in managed care arrangements.