Certified Financial Consultant (CFC) Practice Exam

Who acts as the gatekeeper in a Health Maintenance Organization (HMO)?

1. Primary Care Physician

2. Insurance Agent

3. Control Specialist

4. Risk Manager

The correct answer is: Primary Care Physician

In a Health Maintenance Organization (HMO), the primary care physician serves as the gatekeeper for patient care. This means that the primary care physician is responsible for managing the patient's overall healthcare and directing them to specialists when necessary. This model is designed to control costs and ensure coordinated care, as the primary care physician has comprehensive knowledge of the patient's medical history and needs. The gatekeeping role allows for better management of healthcare services by ensuring that patients receive referrals for specialist services only when appropriate, thus reducing unnecessary tests and procedures. By leveraging the primary care physician's expertise, HMOs aim to maintain high-quality care while keeping costs down. This function is critical to the HMO’s structure, which relies on a network of providers to deliver care efficiently and effectively. In contrast, other roles, such as an insurance agent, control specialist, or risk manager, do not directly engage in patient care management in the same manner. Their roles might focus on selling policies, modifying treatment costs, or analyzing risks, but the primary care physician's gatekeeping function is essential for patient navigation through the healthcare system within an HMO.