Question

1) Provide an overview of managed care and its approach to the utilization of healthcare services.  

2) Managed care has been criticized for how it has gone about reducing healthcare services. Provide an argument if you feel that criticism was warranted or not. Explain your rationale.

HCM

Answer 1

1. Managed care also known as managed healthcare is a system which emphasises more on cost effectiveness in providence of healthcare facilities. It is just another type of health insurance which aims at reducing the cost of services to the consumers, that is, the patients. You see, there is a health insurance company and a healthcare provider like some physician, surgeon, specialist, nurse or a hospital. Both these parties come into a legal contract or an agreement. In such a contract the provider is bound to provide specific services at reduced costs. In turn, the insurance company would drive members towards those practitioners only who signed contracts by limiting their members' options to them.

There are three types of managed care plans-

• HEALTH MAINTENANCE ORGANISATIONS- HMOs typically pay when you choose to get the care within the network. You got to choose a doctor who will coordinate most of your care.
• PREFFERED PROVIDER ORGANISATIONS- They would pay more if you stay within the network and choose providers amongst them. Nonetheless, they'd still pay a part if you choose to go outside the network.
• POINT OF SERVICE - these are plans that let you choose between HMO and PPO everytime you need your check up done.

So basically you gotta pay less when you have restricted options. It will probably cost more if you wish to have a more flexible plan.

Network-based managed care plans integrate the financing and delivery of health care services to covered individuals or members. they do so by means of these four elements:

• arrangements with selected providers to furnish a comprehensive set of health care services to members
• explicit standards for the selection of health care providers
• formal programs for ongoing quality assurance and utilization review
• significant financial incentives for members to use providers and procedures associated with the plan.

Early practitioners of managed care believed that it was a way to improve quality and coordination of care, as well as to increase emphasis on preventative care and home treatment.