National Council for Therapeutic Recreation Certification (NCTRC) Practice Exam

Managed care has shifted the responsibility of determining the services a patient needs to whom?

1. State governments

2. Payers of service

3. Patient

4. Middle class

The correct answer is: Payers of service

The correct answer is that the responsibility of determining the services a patient needs has shifted to payers of service. Managed care emphasizes cost containment and efficiency in healthcare delivery. In this system, payers—such as insurance companies or health maintenance organizations—play a crucial role in deciding which services are covered and how they should be utilized. Payers assess the need for services based on established guidelines and their policy requirements, which influences the patient's access to care. This shift places significant power in the hands of payers, as they can approve or deny services based on perceived medical necessity and cost-effectiveness. Other options do not accurately represent current trends in managed care. For example, state governments may regulate but do not directly determine individual patient services under managed care. Patients themselves may express needs and preferences, but the final decision-making power typically resides with the payers. The middle class, while potentially affected by healthcare access and costs, does not hold responsibility for determining services under managed care frameworks. Thus, the focus on payers as the decision-makers aligns with the realities of managed care dynamics.