Illinois Health Insurance Practice Exam

What does Managed Health Care (MHC) require participants to do?

1. Receive treatment without referrals

2. See a specialist directly

3. Consult a primary care physician known as a "gatekeeper"

4. Choose any healthcare provider at any time

The correct answer is: Consult a primary care physician known as a "gatekeeper"

Managed Health Care (MHC) structures its approach around the concept of coordinated care, and a key component of this model is the role of a primary care physician, often referred to as a "gatekeeper." The gatekeeper is responsible for overseeing and coordinating the patient’s healthcare, including referrals to specialists. This system is designed to manage costs while ensuring that patients receive appropriate care through a structured pathway, which ultimately helps in monitoring and controlling healthcare expenses. In this context, having a primary care physician as the focal point for medical consultations ensures that patients engage in preventive care and receive treatment only when necessary, rather than seeking specialist care directly. This reliance on a primary care physician helps to streamline processes within the healthcare system and maintain a higher quality of care. Other responses imply a more unrestricted access to healthcare providers, which contrasts with the managed model that emphasizes coordination and oversight of healthcare services. Thus, the correct understanding of Managed Health Care highlights the importance of the primary care physician's role in guiding and managing a participant's health journey.