Question

Which of the following technique(s) is(are) used by insurers to control the cost of delivering health care?

O concurrent review programs.
O medical service exclusions.
O alternative sites of care.
O point-of-service reviews.
O second surgical opinions.
O pre-admission certification.
O case management programs.
O all of the above.

Answer 1

Insurers use techniques such as concurrent review programs, pre-admission certification, and case management programs to control healthcare costs by managing care provision and emphasizing efficient resource allocation among patients.

Step-by-step explanation:

Insurers use a variety of techniques to control the cost of delivering health care. These strategies include:

• Concurrent review programs
• Medical service exclusions
• Alternative sites of care
• Point-of-service reviews
• Second surgical opinions
• Pre-admission certification
• Case management programs

Each of these methods serves to manage expenses by supervising the provision of care, avoiding unnecessary services, ensuring that services are provided in cost-effective settings, and planning care for complex cases efficiently.

In addition to these methods, the structure of health care provision has shifted with a focus on health maintenance organizations (HMOs) and managed care. HMOs provide healthcare with a fixed amount per person enrolled, stressing the allocation of resources efficiently among patients. Furthermore, the Affordable Care Act (ACA) introduced measures like administrative cost caps and the switch to electronic medical records (EMRs) to further control costs. These tactics are put in place to mitigate issues like adverse selection and moral hazard, aligning the incentives of providers with the goal of cost control.