Author Question: A major outcome of managed care is that managed care organizations such as hospitals a. Assume ... (Read 122 times)

Deast7027 · **on:** Jul 23, 2018

A major outcome of managed care is that managed care organizations such as hospitals

a. Assume financial risk, as well as provide care.
b. Focus more on individual illness.
c. Decrease discharge planning activities.
d. Have increased lengths of stay.

Question 2

The advent of diagnosis-related groups (DRGs) and capitation has brought about many changes in how health care is provided and paid for. Because of these changes, the nurse is aware that today's managed care system has

a. Insured full coverage of health care costs.
b. Assumed all of the financial risk involved.
c. Allowed providers to focus on illness care.
d. Caused providers to focus on illness prevention.

dpost18 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: A
As a result of managed care and prospective payment systems, the managed care organization assumes financial risk, in addition to providing patient care. The organization's focus of care shifts from individual illness care to concern for the health of its covered population. If people stay healthy, the cost of medical care declines. Soon after prospective payment began, hospitals started to increase discharge planning activities, and lengths of stay began to shorten.

Answer to Question 2

ANS: D
Managed care describes health care systems in which the provider or the health care system receives a predetermined capitated payment for each patient enrolled in the program. Capitation means that providers receive a fixed amount per patient or enrollee of a health care plan. The actual cost of care is the responsibility of the provider. In this case, the managed care organization (provider) assumes financial risk, in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care.