Question

(a) Name three key elements that distinguish managed care from traditional FFS insurance. What was the primary change from traditional FFS insurance?

(b) Describe how incentives may di§er between traditional FFS insurance and HMOs from a dynamic perspective

Answer 1

A} The main elements which distinguish the Managed care from the Traditional FFS insurance are as follows;

The main elements are the cost, utilization of services and the Provider access and clinical quality. Through the introduced managed care, it ensure firstly about the cost which means that it will reduce the cost by the better management performance. And to the next it will improve the access to the plan and also it will increase the utilization by the better ideas and proper conditions. And thirdly it mainly concerns about the clinical quality and it will step-up the standard by the managed care. The primary change from the traditional FFS insurance is the importance given to the outcome. In FFS there Rewards are added without proper examine in the quality of the care. But in managed care the quality of care is an important factor. And under HMO, the selection of physicians are restricted to the list, that is a great difference from traditional FFS.

B} When the FFS is compared with the HMO the incentives are a bit different. In FFS you have to consult the doctor and after the Traitement you have to settle as out-of pocket payment and you have to claim for it with all papers which makes them more expensive and under the HMO this a bit different and the ways adopted here will try to reduce the expense and make more worthy.