Question: A fixed-payment plan of health insurance offers coverage for

Answer: D. complete medical care.

Question: Third-party payers are

Answer: A. insurance companies.

Question: The purpose of the gatekeeper is to

Answer: ALL OF THE ABOVE. approve tests before they are given, approve all nonemergency services, & approve hospitalizations.

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

Answer: ALL OF THE ABOVE. organization, physician, & hospital.

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

Answer: A. prohibits the physician from discussing financial incentives given by the organization.

Question: Managed care organizations may attempt to limit a patient’s

Answer: ALL OF THE ABOVE. referrals to specialists, choice of hospitals, & length of stay in a hospital.

Question: A health maintenance organization (HMO) provides

Answer: A. healthcare services available for a predetermined fee per member by a limited group of providers.

Question: Capitation is

Answer: D. a fixed monthly fee paid to the healthcare provider for providing patient services.

Question: Medicare is a federal program of

Answer: B&C. healthcare coverage for the elderly and disabled & healthcare coverage in which rationing of care might occur in the future.

Question: Medicaid is a

Answer: D. federal program of care for the poor implemented by the states.