Term
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Definition
| a delivery system that allows the enrollee access to all health care services, but the enrollee is assigned a primary care physician who manages all the health care needs of the enrollee and acts as a gatekeeper for the enrollee |
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Term
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Definition
| T or F: Services are prepaid by the HMO |
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Term
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Definition
| Who authorizes an HMO's enrollee's access to services? |
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Term
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Definition
| What two models are used to employ primary care physicians in an HMO? |
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Term
| Exclusive Provider Organization |
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Definition
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Term
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Definition
| group that has many of the same features as an HMO except that the providers of the services are not prepaid, but are paid on a fee-for-service basis |
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Term
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Definition
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Term
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Definition
| form of HMO in which an organization of physicians contracts with the HMO to provide services to the enrollees of the HMO. Payment is negotiated, the HMO pays the group, and then the group pays the individual physicians. |
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Term
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Definition
| Which Medicare program is an HMO? |
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Term
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Definition
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Term
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Definition
| benefits allow enrollees to receive services outside of the HMO's health care network, but at increased cost in copayments, in coinsurance, or in a deductible |
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Term
| open-ended HMO, self-referral option |
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Definition
| What are two other names for POS? |
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Term
| Program for All-Inclusive Care for the Elderly |
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Definition
| What does PACE stand for? |
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Term
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Definition
| a program developed to address the needs of long-term care clients, providers, and payers--allowing clients to continue to live in their homes while receiving services rather than being placed in an institution |
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Term
| Physician's have an incentive to keep health care costs down rather than what is in the best interest of the patient. |
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Definition
| What is one major drawback of an HMO? |
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