{"id":170422,"date":"2024-11-19T20:03:33","date_gmt":"2024-11-19T20:03:33","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=170422"},"modified":"2024-11-19T20:03:37","modified_gmt":"2024-11-19T20:03:37","slug":"under-what-system-do-a-group-of-doctors-and-hospitals-in-a-designated-area-contract-with-an-insurer-to-provide-services-at-a-prearranged-cost-to-the-insured","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2024\/11\/19\/under-what-system-do-a-group-of-doctors-and-hospitals-in-a-designated-area-contract-with-an-insurer-to-provide-services-at-a-prearranged-cost-to-the-insured\/","title":{"rendered":"Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured"},"content":{"rendered":"\n

Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?<\/p>\n\n\n\n

The Correct Answer and Explanation is:<\/mark><\/strong><\/p>\n\n\n\n

The correct answer is Health Maintenance Organization (HMO)<\/strong>.<\/p>\n\n\n\n

Explanation:<\/h3>\n\n\n\n

A Health Maintenance Organization (HMO)<\/strong> is a type of managed care system where a group of healthcare providers, including doctors, hospitals, and other medical professionals, contracts with an insurer to deliver healthcare services to members for a prearranged fee. This system is designed to control costs while ensuring a comprehensive range of healthcare services to enrolled individuals.<\/p>\n\n\n\n

Key Features of HMOs:<\/h4>\n\n\n\n
    \n
  1. Network of Providers<\/strong>: Members must receive care from a specific network of providers to get coverage. The HMO contracts with these providers, who agree to deliver services at reduced rates.<\/li>\n\n\n\n
  2. Prepaid Cost Structure<\/strong>: HMOs operate on a prepaid basis. Members pay a fixed monthly premium, covering most services without additional costs, except for small co-payments for office visits or prescriptions.<\/li>\n\n\n\n
  3. Primary Care Physician (PCP)<\/strong>: Members are often required to select a PCP who acts as a gatekeeper. The PCP coordinates all care and provides referrals to specialists within the HMO network.<\/li>\n\n\n\n
  4. Focus on Preventative Care<\/strong>: HMOs emphasize preventive healthcare services, such as vaccinations, routine check-ups, and screenings, to reduce the need for more expensive treatments.<\/li>\n<\/ol>\n\n\n\n

    Advantages:<\/h4>\n\n\n\n
      \n
    • Cost Control<\/strong>: HMOs reduce out-of-pocket expenses for members and help control overall healthcare costs by negotiating rates and limiting unnecessary procedures.<\/li>\n\n\n\n
    • Comprehensive Care<\/strong>: Members receive a broad range of services, including emergency care, maternity services, and wellness programs.<\/li>\n\n\n\n
    • Streamlined Coordination<\/strong>: The PCP ensures that care is well-coordinated and effective.<\/li>\n<\/ul>\n\n\n\n

      Limitations:<\/h4>\n\n\n\n
        \n
      • Limited Flexibility<\/strong>: Members are restricted to in-network providers. Out-of-network care is usually not covered, except in emergencies.<\/li>\n\n\n\n
      • Referrals Required<\/strong>: Access to specialists often requires a referral from the PCP.<\/li>\n<\/ul>\n\n\n\n

        In summary, an HMO system aims to balance cost efficiency with quality care, making it a popular choice for both insurers and individuals seeking affordable healthcare coverage.<\/p>\n","protected":false},"excerpt":{"rendered":"

        Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured? The Correct Answer and Explanation is: The correct answer is Health Maintenance Organization (HMO). Explanation: A Health Maintenance Organization (HMO) is a type of managed care system […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-170422","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/170422","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=170422"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/170422\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=170422"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=170422"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=170422"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}