Certified Financial Consultant (CFC) Practice Exam

What is the primary purpose of managed care health insurance plans?

1. Provide comprehensive coverage

2. Control health insurance claims expenses

3. Facilitate patient referrals

4. Expand hospital networks

The correct answer is: Control health insurance claims expenses

The primary purpose of managed care health insurance plans is to control health insurance claims expenses. These plans are designed to manage the cost of healthcare services while still providing access to essential medical care. By implementing various strategies such as negotiating rates with healthcare providers, promoting preventive care, and managing patient care through a network of providers, managed care aims to minimize unnecessary spending and enhance the overall efficiency of healthcare delivery. This cost control mechanism is critical in a managed care environment because it allows insurance companies to keep premiums lower for policyholders while ensuring that healthcare providers are compensated for services rendered. The emphasis on cost control also encourages the use of evidence-based practices, which can lead to better health outcomes and reduced healthcare costs over time. While comprehensive coverage, patient referrals, and hospital network expansion are also important aspects of healthcare delivery, they are secondary to the overarching goal of managing and controlling expenses in managed care plans. This focus on cost containment directly influences members’ access to care, overall satisfaction with their health plans, and the sustainability of the insurance system as a whole.