The advent of diagnosis-related groups (DRGs) and capitation has brought about many changes in how health care is provided and paid for. Because of these changes, the nurse is aware that today's managed care system has
a. Insured full coverage of health care costs.
b. Assumed all of the financial risk involved.
c. Allowed providers to focus on illness care.
d. Caused providers to focus on illness prevention.
ANS: D
Managed care describes health care systems in which the provider or the health care system receives a predetermined capitated payment for each patient enrolled in the program. Capitation means that providers receive a fixed amount per patient or enrollee of a health care plan. The actual cost of care is the responsibility of the provider. In this case, the managed care organization (provider) assumes financial risk, in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care.
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