Question

What is the role of the primary care physician in an HMO insurance program?

A) Provide emergency care services

B) Coordinate and manage the patient's overall healthcare, serving as a gatekeeper for specialized services

C) Perform surgical procedures

D) Handle administrative tasks related to insurance claims

Answer 1

The primary care physician in an HMO insurance program manages and coordinates the patient's overall healthcare, acting as a gatekeeper for specialized services and focusing on the efficient use of healthcare resources.

Step-by-step explanation:

The role of the primary care physician in an HMO insurance program is to coordinate and manage the patient's overall healthcare. This includes serving as a gatekeeper for specialized services. In an HMO, medical care providers receive a fixed payment per enrolled person, regardless of the number of services provided.

This payment model incentivizes healthcare providers to focus on the efficient allocation of resources and to manage each patient's care to avoid unnecessary procedures while ensuring their health needs are met. As such, the primary care physician's role involves a significant amount of responsibility for continuous patient care and decision-making regarding referrals to specialists.