Research shows that issues with access to both primary care and specialty care prevail in:
Preferred Provider Organization (PPO) plan
Medicare advantage plans.
Medicaid managed care.
Health Maintenance Organization (HMO) plans
The Correct Answer is D
Rationale:
A. Preferred Provider Organization (PPO) plan: PPO plans typically offer members greater flexibility in choosing healthcare providers and may not have as strict requirements for referrals to specialists, reducing barriers to access.
B. Medicare advantage plans: Medicare Advantage plans, also known as Medicare Part C, offer additional benefits beyond traditional Medicare, but they may not exhibit the same issues with access to primary and specialty care as other managed care plans.
C. Medicaid managed care: Medicaid managed care plans vary by state and may have different structures for accessing care, but they often emphasize primary care coordination and may not exhibit the same issues with access as HMO plans.
D. Health Maintenance Organization (HMO) plans: HMO plans typically require members to select a primary care physician (PCP) and obtain referrals from the PCP to see specialists. This structure can create barriers to accessing specialty care, particularly if there are limitations in provider networks or delays in obtaining referrals.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Concurrent: Concurrent utilization review involves the ongoing monitoring of a patient's care and recovery while they are still receiving treatment. This type of review focuses on ensuring that the care provided is appropriate and that the patient is progressing as expected.
B. Preauthorization: Preauthorization involves obtaining approval from a health insurer before a service is provided to ensure it will be covered. It does not focus on monitoring a patient's recovery.
C. Retrospective: Retrospective review involves evaluating the care provided to a patient after the treatment has been completed. It looks at the appropriateness of care but does not monitor ongoing recovery.
D. Prospective: Prospective review involves evaluating the necessity of a treatment before it begins. It does not include ongoing monitoring of a patient's prognosis for recovery.
Correct Answer is C
Explanation
Rationale:
A. Beliefs and values of Americans: While public opinion and support may influence the fate of healthcare policies, the survival of the Affordable Care Act (ACA) has been significantly
impacted by legal challenges and court rulings.
B. Moderation of health care costs: While controlling healthcare costs is an important goal of the ACA, it has not been the primary factor ensuring its survival.
C. Court rulings: Legal challenges to various aspects of the ACA, including its constitutionality and implementation, have led to significant court rulings that have shaped and determined its survival.
D. Political maneuvering: Political factors and maneuvering have certainly played a role in debates and attempts to repeal or modify the ACA, but court rulings have been more directly influential in determining its survival.
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