Final answer:
Case Management is the approach for providing cost-effective care management for patients with complex medical conditions. Medicare serves as a public healthcare system for individuals over sixty-five, while HMOs reimburse providers per capita. Adverse selection is a risk in insurance markets affecting costs.
Step-by-step explanation:
Cost-effective management of care for patients who have complex medical conditions is best described as Case Management. This approach is designed to coordinate all aspects of care for patients with multifaceted health issues, often overseen by a case manager who works with the patient, healthcare providers, and insurers to navigate treatment options, reduce costs, and ensure the efficient delivery of health services.
The United States healthcare system has diverse models for organizing and financing medical care. For example, Medicare is a public healthcare system offering insurance primarily to people over sixty-five years old, whereas health maintenance organizations (HMOs) consist of medical care providers who receive reimbursement per capita rather than for the cost of services they provide.
Adverse selection poses a risk in insurance markets, especially when high-risk individuals are more likely to purchase insurance than low-risk individuals, potentially leading to higher costs for insurers.