Question

What are the theories of Managed Care Cost Savings? Discuss from both consumer-and provider-side provisions.

Answer 1

Managed care cost savings is a type of health insurance which tries to provide care at reduced costs.

Theories of this are members are restricted to provider network, there are gatekeepers, selection of providers, practice profiling, utilisation review, and case management.

From the consumer perspective and provision, there is member choice restriction, wherein patients may not be able to visit any other physicians which are outside their plan, they will have to pay if they visit other physicians. Patients must see PCP before they see any other physician, service or hospital. Providers are based on quality, costs and utilisation.

From the provider side provisions there are practice guidelines which they have to follow, there is a review done on concurrent basis and discharge planning is done. Health care professional monitors the care given to the patient. They are reimbursed by giving them salary and other discounted charges. Providers are willing to accept utlization review as they have excess capacity and need more patients.