Chapter 4 Today's Healthcare Environment

A fixed-payment plan of health insurance offers coverage for

• hospital care.
• physicians' visits.
• complete medical care.
• dental care.

Third-party payers are

• physicians.
• insurance companies.
• patients.
• hospitals.

The purpose of the gatekeeper is to

• approve all nonemergency services.
• approve hospitalizations.
• approve tests before they are given
• all of the above.

In a managed care organization, financial risk is shared by the

• organization.
• hospital.
• physician.
• all of the above.

A gag clause, considered illegal in contracts between physicians and managed care organizations

• prohibits the physician from discussing the income of the organization.
• allows the physician to share financial incentives only with patients.
• prohibits the physician from discussing financial incentives given by the organization.
• allows the managed care organization to refuse to pay for care given by the physician.

Managed care organizations may attempt to limit a patient's

• choice of hospitals.
• referrals to specialists.
• length of stay in a hospital.
• all of the above.

A health maintenance organization (HMO) provides

• healthcare services available for a predetermined fee per member by a limited group of providers.
• no preventive care services
• healthcare services by requiring a large copayment. 
• healthcare services through a nonrestricted group of providers.

Capitation is

• a fixed monthly fee paid to the healthcare provider for providing patient services.
• an additional payment for services paid directly by the patient at the time of service.
• limitation of all services for care to a fixed dollar amount.
• a fixed amount the managed care organization may charge the patient for membership in the organization.

Medicaid is a

• federally implemented program for indigent care.
• state-funded program for indigent care.
• federal program of care for the poor implemented by the states.
• locally implemented program of indigent care.

A Medicare-instituted method of hospital payment is

• the classification of patients of illness by diagnosis.
• persons without funds.
• limiting care to a certain number of persons with a diagnosis.
• limiting care to a set number of days.