Question

Managerial Epidemiology Cases and Concepts - 180 Day Option, 3rd Edition
Steven T. Fleming

managed care and fee-for-service health plans. In a short paragraph,

describe how these two plans are similar and different. Next, respond to the following question:

Does managed care give greater accountability for quality of care than fee-for service?

Why or why not? Use at least one specific example in your post

Answer 1

Managed care are a type of health insurance. They have contracts with the health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan's network. How much of your care the plan will pay for depends on the network's rules. If you want a flexible plan, it will probably costs more.

Fee for service is a traditional type of insurance in which the health plan will either pay the medical provider directly or reimburse you after you have filed an insurance claim for each covered medical expense. When you need medical attention, you visit the doctor or hospital of your choice. This approach may be expensive for you and require extra paper work.

Managed care vs Fee for Service

parameter	Fee for Service	Managed care
How you choose a physician	you can go to see any physician you want	There is a strong financial incentive to see only those physicians who are affiliated with the plan
how you consult a specialist	you can see any speicialist whenever you like though some specialists prefer a referral from your general practitioner	you are referred to a specialist only if your primary care physician determines one is necessary.
Scope of Periodic checkk ups	do not include cancer screening tests like mammograms	periodic check up by primary care physician is paid for by the plan and may be accompanied by by reminders to get regular preventive screening tests, which are also covered
Method of payment	after paying the yearly deductible, you will probably be asked to pay the physician's bill upfront . Later you should submit claim to be reimbursed for a certain percentage of amount	you will be charged $5, $10 or $15 co payment when you see a doctor. But it is the doctors responsibility to file the necessary paperwork with the managed care plan
Quality and Qualifications of physicians	qualifications will vary from doctor to doctor. You alone are responsible for checking a physicians qualifications and credentials as well as for making sure you are getting appropriate treatment once you are under a physicians care.	the plan takes on the responsibility of determining whether doctors are qualified when it invites them into network. Nationally, 81 percent of physicians participating in managed care plans are board certified

Managed care have greater accountability for quality of care than fee for service due to following reasons:

1. Preventive care services are often included for example annual physical check ups, diabetes screenings, HIV screenings, cardiovascular screenings etc.
2. The yearly deductible is reasonably low and also features lower co-payments.
3. The doctors are qualified and board certified.
4. Managed care plans usually offer low up- front costs or low premiums