Basics of the U.S. Health Care System Chapter 9 Exam Questions
and Answers with Verified Solutions | Latest 2026 Update
Q: The cost management of healthcare services by controlling who the consumer
sees and how much the service costs
Answer:
Managed Care
Q: Managed Care Organization
Answer:
MCO
Q: Healthcare costs were spiraling out of control, providers could charge
whatever they wanted for their services
Answer:
Why was managed care created?
Q: HMO
Answer:
This was the first Managed Care Model
Q: This is also known as an indemnity plan, increases the cost of healthcare
because there are no controls on how much to charge for provider's service
Answer:
Fee-for-service system
Q: Paid at rate per patient, limits the amount the provider will be paid per service
Answer:
Capitation Rate
Establish a relationship with organizations and providers to offer a designated set
of services to their members
Establish a criteria for their members to utilize the MCO
Establish measures to estimate cost control
Provide incentives to encourage health service resources
Provide and encourage utilization programs to improve the health status of their
enrollees -
, Characteristics of all MCOs
Q: Health Maintenance Organization
Answer:
HMO
Q: Oldest type of managed care, members must see their primary care provider
first in order to see a specialist
Answer:
What is an HMO?
Q: Type of HMO, hires providers to work at a physical location
Answer:
Staff Model
Q: Type of HMO, first type of HMO model introduced by Kaiser Permanente,
negotiates with a group of physicians exclusively to perform services
Answer:
Group Model
Q: Type of HMO, similar to Group Model, but these providers may see other
patients who are not members of the HMO. There is a negotiated rate for
service for members to see providers who belong to the network.
Answer:
Network Model
Q: Type of HMO, contract with a group of physicians who are in private practice
to see MCO members at a prepaid rate per visit. The physicians may sign
contracts with many HMOs and may see non-HMO patients, was a result of
the HMO Act of 1973.
Answer:
Independent Practice Association (IPA)
and Answers with Verified Solutions | Latest 2026 Update
Q: The cost management of healthcare services by controlling who the consumer
sees and how much the service costs
Answer:
Managed Care
Q: Managed Care Organization
Answer:
MCO
Q: Healthcare costs were spiraling out of control, providers could charge
whatever they wanted for their services
Answer:
Why was managed care created?
Q: HMO
Answer:
This was the first Managed Care Model
Q: This is also known as an indemnity plan, increases the cost of healthcare
because there are no controls on how much to charge for provider's service
Answer:
Fee-for-service system
Q: Paid at rate per patient, limits the amount the provider will be paid per service
Answer:
Capitation Rate
Establish a relationship with organizations and providers to offer a designated set
of services to their members
Establish a criteria for their members to utilize the MCO
Establish measures to estimate cost control
Provide incentives to encourage health service resources
Provide and encourage utilization programs to improve the health status of their
enrollees -
, Characteristics of all MCOs
Q: Health Maintenance Organization
Answer:
HMO
Q: Oldest type of managed care, members must see their primary care provider
first in order to see a specialist
Answer:
What is an HMO?
Q: Type of HMO, hires providers to work at a physical location
Answer:
Staff Model
Q: Type of HMO, first type of HMO model introduced by Kaiser Permanente,
negotiates with a group of physicians exclusively to perform services
Answer:
Group Model
Q: Type of HMO, similar to Group Model, but these providers may see other
patients who are not members of the HMO. There is a negotiated rate for
service for members to see providers who belong to the network.
Answer:
Network Model
Q: Type of HMO, contract with a group of physicians who are in private practice
to see MCO members at a prepaid rate per visit. The physicians may sign
contracts with many HMOs and may see non-HMO patients, was a result of
the HMO Act of 1973.
Answer:
Independent Practice Association (IPA)
