Managed Health Care and Health Insurance Practices Quiz
Test your understanding of managed care, health insurance practices, HMOs, PPOs, and more with this healthcare economics quiz!
#1
Which of the following is a characteristic of managed care organizations (MCOs)?
They primarily focus on maximizing profits for shareholders.
They emphasize preventive care and cost-effective treatments.
They have no restrictions on the choice of healthcare providers.
They offer fee-for-service payment models exclusively.
#2
What is the main purpose of a health maintenance organization (HMO)?
To provide comprehensive healthcare services for a fixed monthly fee.
To offer flexibility in choosing healthcare providers.
To focus on providing specialized medical treatments.
To operate primarily on a fee-for-service payment model.
#3
Which of the following is NOT a type of managed care organization?
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
Exclusive Provider Organization (EPO)
Consumer-Directed Health Plan (CDHP)
#4
Which of the following is a characteristic of a high-deductible health plan (HDHP)?
It has low out-of-pocket expenses for policyholders.
It typically features higher monthly premiums.
It does not require individuals to have a health savings account (HSA).
It covers all medical expenses without any cost-sharing.
#5
Which of the following is NOT a type of cost-sharing in health insurance?
Deductible
Co-insurance
Premium
Co-payment
#6
Which federal program provides health insurance coverage for individuals aged 65 and older?
Medicaid
Medicare
CHIP (Children's Health Insurance Program)
Obamacare (Affordable Care Act)
#7
What is a primary feature of a preferred provider organization (PPO)?
It requires members to select a primary care physician (PCP).
It offers a wide network of healthcare providers, giving members the freedom to choose.
It only covers emergency medical services.
It provides healthcare services exclusively through telemedicine.
#8
Which of the following statements best describes a Health Savings Account (HSA)?
An account where individuals can deposit pre-tax dollars to be used for qualified medical expenses.
A type of insurance plan that covers only catastrophic medical events.
A government program that provides free healthcare to low-income individuals.
An account managed by insurance companies to invest premiums paid by policyholders.
#9
What is the main function of utilization management in managed care?
To ensure healthcare providers receive timely payments for services rendered.
To assess the appropriateness and necessity of healthcare services provided to patients.
To negotiate discounts with pharmaceutical companies for prescription drugs.
To promote wellness programs and preventive care initiatives.
#10
Which federal agency regulates managed care organizations in the United States?
Centers for Medicare & Medicaid Services (CMS)
Food and Drug Administration (FDA)
Federal Trade Commission (FTC)
Occupational Safety and Health Administration (OSHA)
#11
What is the role of a primary care physician (PCP) in managed care?
To perform surgical procedures on patients.
To coordinate and manage the overall healthcare of patients, including referrals to specialists.
To handle administrative tasks within the managed care organization.
To provide emergency medical services exclusively.
#12
In the context of health insurance, what does 'co-payment' refer to?
A fixed amount that the insured individual must pay for covered services at the time of service.
A percentage of covered expenses that the insured individual must pay after meeting the deductible.
The total amount the insured individual pays annually before the insurance company begins to cover expenses.
The limit on out-of-pocket expenses that the insured individual is responsible for in a given year.
#13
What is the primary purpose of risk sharing in health insurance?
To transfer financial risk from insurers to policyholders.
To ensure healthcare providers share the financial burden of insurance claims.
To eliminate the need for deductibles and co-payments.
To prevent individuals with pre-existing conditions from obtaining coverage.
#14
Which of the following factors contributes to the concept of 'adverse selection' in health insurance?
Encouraging healthy individuals to enroll in insurance plans.
Providing comprehensive coverage for all medical conditions.
Attracting individuals with pre-existing health conditions to enroll in insurance plans.
Offering discounted premiums for policyholders who maintain good health habits.
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