5 describe the two purposes of managed care a 1 to

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5. Describe the two purposes of managed care. A: 1. To control healthcare cost 2. Ensure quality of care. 6. Why have many insurers replaced retrospective health insurance plans with group plans such as HMOs and PPOs? A: It’s cost effective and the pt responsibility is lower than the traditional retrospective method. 7. What are advantages of capitated payments for providers and payers? A: It’s a set payment paid to the provider regardless of how many patient’s is seen per month essentially, less risk for the payer. 8. How do third-party payers set per diem payment rates? A: payer reimburses the provider a fixed rate for each day during which a covered member is hospitalized.
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9. Describe the major benefits of episode-of-care reimbursement according to its advocates, as well as the major concerns about episode-of-care reimbursement expressed by its critics. A: 10. Why is the constant trend of increased national spending on healthcare a concern? A: Money is a limited resource and rising healthcare cost is stifling economic growth, and putting a burden on businesses, and public sector, individual and families. The constant increase in spending negatively effects the economy and families. Additionally, taking money away from other sectors such as education and roads etc.
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  • Fall '17

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