Answer to Question 1
b
Answer to Question 2
Traditional systems of health care include a billing system in which the provider of care charges a fee for each service rendered. While this type of insurance has become relatively uncommon, proponents of fee-for-service systems prefer the greater flexibility and unrestricted access to physicians, tests, hospitals, and treatments. The managed care system is an approach to paying for health care in which insurers try to limit the use of health services, reduce cost, or both. A utilization review aims to prevent unnecessary treatment by requiring enrollees to obtain approval for nonemergency hospital care, denying payment for wasteful treatment, and monitoring severely ill patients to ensure that they get cost-effective care. Managed forms of health care include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service plans (POSs). The presumed goal of managed care is improved quality of care with decreased costs.
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