Final answer:
The method of controlling costs and quality of care through pre-care review is Utilization Review. It is key in HMOs for maintaining cost effectiveness. Additionally, it's crucial to address how cost control aligns with quality care, patient privacy, and treatment prioritization amidst challenges like adverse selection.
Step-by-step explanation:
The method of controlling costs and quality of care by reviewing the need for care before it is provided is known as Utilization Review (a). Utilization Review involves a process where the appropriateness, medical necessity, and efficiency of the use of health care services, procedures, and facilities are evaluated before the care is provided. This is particularly important within Health Maintenance Organizations (HMOs), which work on a capitated payment system, where providers receive a set amount per patient regardless of how many services the patient uses, incentivizing cost-effective and efficient care.
When developing policies to balance the costs of treatments and diagnoses, patient quality of life, and risks to individual privacy, one must consider:
Furthermore, in health financing systems, the concept of adverse selection is a significant challenge, as it can lead to a disproportion of high-risk individuals opting for insurance plans, thus increasing costs for insurance providers.