In managed care, how is cost containment typically achieved?

• A. No pre-authorization for any service.
• B. High priority on cost containment; predetermined providers; PCP gatekeeping.
• C. Capitation is not used.
• D. Patients pay full price without co-pays.

Answer: (B)

Cost containment in managed care is achieved by coordinating care through a primary care physician who acts as a gatekeeper and by operating within a defined network of providers with negotiated rates. This approach keeps utilization in check by ensuring referrals and services are appropriate, necessary, and delivered at predictable costs. The best answer describes a plan that emphasizes cost containment, uses predetermined providers within a network, and relies on PCP gatekeeping to authorize referrals and procedures. Capitation—paying providers a fixed amount per patient to incentivize efficient care—is a common mechanism in such plans, reinforcing cost control, though the core idea here centers on gatekeeping and a contracted network. Other options don’t fit because removing pre-authorization loosens control over utilization, capitation is indeed used in many managed care plans, and paying patients full price without co-pays removes the cost-sharing that helps moderate demand.