Health Care in the U.S. Chapter 9 Exam Questions and Answers
with Verified Solutions | Latest 2026 Update
Q: pre-negotiated schedule deciding when a provider is paid by an MCO
Answer:
fee schedule
Q: AKA fee-for-service insurance; allows insured to obtain health care services
anywhere and from any physician or hospital
Answer:
indemnity insurance
Q: providers selected to render services to members of an MCO; "preferred
providers"
Answer:
panel
Q: services obtained outside panel not covered by managed care plan
Answer:
closed-panel
plan allows access to providers outside of panel, but enrollees have to pay higher
out-of-pocket costs -
open-panel
Q: organized approach to evaluating and coordinating care, particularly for
patients w/ complex/costly problems that require variety of services from
multiple providers over extended period
Answer:
case management
Q: position-oriented strategy for people with chronic conditions; based on
well-established, evidence-based treatment guidelines
Answer:
disease management
Q: list of prescription drugs approved by health plan
, Answer:
formulary
Q: process of evaluating appropriateness of services provided
Answer:
utilization review
Q: determines appropriateness of utilization before care is delivered
Answer:
prospective utilization review
Q: determines on daily basis the length of stay necessary in hospital; also
monitors use of ancillary services and makes sure care provided is appropriate
Answer:
concurrent utilization review
Q: focuses on post-discharge continuity of care
Answer:
discharge planning
Q: review of utilization after services have been delivered
Answer:
retrospective utilization review
development of physician-specific practice patterns and comparison of individual
practice patterns to some norm; may incorporate patient satisfaction surveys and
compliance w/ clinical practice guidlines -
practice profiling
Q: combine features of indemnity insurance, HMO, and PPO; insured has
flexibility to choose which feature to use when using health care services
Answer:
triple-option plans
Q: type of managed care organization that provides comprehensive medical care
for predetermined annual fee per enrollee
with Verified Solutions | Latest 2026 Update
Q: pre-negotiated schedule deciding when a provider is paid by an MCO
Answer:
fee schedule
Q: AKA fee-for-service insurance; allows insured to obtain health care services
anywhere and from any physician or hospital
Answer:
indemnity insurance
Q: providers selected to render services to members of an MCO; "preferred
providers"
Answer:
panel
Q: services obtained outside panel not covered by managed care plan
Answer:
closed-panel
plan allows access to providers outside of panel, but enrollees have to pay higher
out-of-pocket costs -
open-panel
Q: organized approach to evaluating and coordinating care, particularly for
patients w/ complex/costly problems that require variety of services from
multiple providers over extended period
Answer:
case management
Q: position-oriented strategy for people with chronic conditions; based on
well-established, evidence-based treatment guidelines
Answer:
disease management
Q: list of prescription drugs approved by health plan
, Answer:
formulary
Q: process of evaluating appropriateness of services provided
Answer:
utilization review
Q: determines appropriateness of utilization before care is delivered
Answer:
prospective utilization review
Q: determines on daily basis the length of stay necessary in hospital; also
monitors use of ancillary services and makes sure care provided is appropriate
Answer:
concurrent utilization review
Q: focuses on post-discharge continuity of care
Answer:
discharge planning
Q: review of utilization after services have been delivered
Answer:
retrospective utilization review
development of physician-specific practice patterns and comparison of individual
practice patterns to some norm; may incorporate patient satisfaction surveys and
compliance w/ clinical practice guidlines -
practice profiling
Q: combine features of indemnity insurance, HMO, and PPO; insured has
flexibility to choose which feature to use when using health care services
Answer:
triple-option plans
Q: type of managed care organization that provides comprehensive medical care
for predetermined annual fee per enrollee
