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Multiple Choice

Which statement best describes managed care?

Managed care is a system that coordinates financing and delivery of health care to control costs and improve quality. It typically uses an organized network of providers who agree to set prices and standards of care, and it often includes a gatekeeper such as a primary care physician who coordinates a patient’s care and may require referrals to see specialists. Utilization management involves reviewing services for medical necessity, obtaining prior authorizations, and monitoring care to avoid unnecessary or duplicative procedures. By aligning payments with coordinated care—often through arrangements like networks and capitation—managed care aims to keep costs down while maintaining or improving quality. This differs from fee-for-service models that pay for each service with little utilization control, and from a government-only emergency care program or from metrics like hospital rankings that measure quality rather than organize financing and delivery.

Managed care is a system that coordinates financing and delivery of health care to control costs and improve quality. It typically uses an organized network of providers who agree to set prices and standards of care, and it often includes a gatekeeper such as a primary care physician who coordinates a patient’s care and may require referrals to see specialists. Utilization management involves reviewing services for medical necessity, obtaining prior authorizations, and monitoring care to avoid unnecessary or duplicative procedures. By aligning payments with coordinated care—often through arrangements like networks and capitation—managed care aims to keep costs down while maintaining or improving quality. This differs from fee-for-service models that pay for each service with little utilization control, and from a government-only emergency care program or from metrics like hospital rankings that measure quality rather than organize financing and delivery.