Question 55

Specialists can choose to be gatekeepers for their patients.

In the context of the gatekeeper system, specialists do not have the authority to act as gatekeepers; rather, this role is typically designated to primary care physicians (PCPs) who manage patient referrals.

A) gatekeepers are a common feature of HMO plans.

This statement is true as gatekeepers are indeed a standard aspect of Health Maintenance Organization (HMO) plans, where a primary care physician oversees and coordinates patient care, including referrals to specialists.

B) specialists can choose to be gatekeepers for their patients.

This statement is incorrect because the gatekeeper role is specifically assigned to primary care physicians. Specialists typically do not have the authority to act as gatekeepers, as their main function is to provide specialized care rather than manage the overall healthcare process for patients.

C) referrals to specialists must be authorized by the gatekeeper.

This statement is true, as one of the primary responsibilities of a gatekeeper (usually a primary care physician) is to authorize referrals to specialists. This mechanism helps control healthcare costs and ensure that patients receive appropriate care.

D) the insured must select a primary care physician who authorizes all care for insured.

This statement is accurate, as individuals enrolled in HMO plans are required to choose a primary care physician who acts as their gatekeeper and is responsible for authorizing all necessary medical care, including specialist visits.

Conclusion

The correct answer is B because it incorrectly implies that specialists can take on the gatekeeper role, which is not the case in the gatekeeper system. All other options correctly describe the functions and requirements associated with gatekeepers in HMO plans, emphasizing the central role of primary care physicians in managing patient care and referrals.