Final answer:
Reimbursement under the Medical Care Program may not be made for unnecessary, not cost-effective, or fraudulent services. The fee-for-service system and health maintenance organizations (HMOs) structure reimbursements differently, with HMOs focusing on preventing overutilization. Implementations like the ACA also affect reimbursement policies.
Step-by-step explanation:
Under the Medical Care Program, reimbursement may not be made for a variety of reasons. One of the main concerns in a fee-for-service health financing system is the way providers are reimbursed. Here, providers receive reimbursement according to the cost of services they provide. However, this system encounters issues such as moral hazard and adverse selection, where different risk profiles among patients can affect insurance dynamics. On the contrary, Health Maintenance Organizations (HMOs) reimburse providers based on the number of patients, not the services provided, thus redistributing resources among patients. With the implementation of the Patient Protection and Affordable Care Act (ACA or Obamacare), there have been further changes to how medical care costs are managed and what procedures and services are covered.
In this context, reimbursements may not be made for services that are deemed unnecessary, not cost-effective, or fraudulent. For example, after the establishment of Medicare and Medicaid, some clinics conducted unnecessary and expensive tests to defraud the government, which would not be reimbursed under properly regulated systems. Similarly, under managed care arrangements like HMOs, there is an emphasis on preventing overutilization of services. Therefore, reimbursement may not be made for excessive services or those not aligned with the managed care model.