Managed Care

Managed care in today’s world seems to lean in favor of the insurance carriers rather than the patient or provider. Providers that try to operate a cash practice take a huge risk and it is almost necessary for them to participate in insurance plans for their business to succeed.
Some of the advantages of managed care include predetermined co-pays, older adults not eligible for Medicaid can get insurance coverage, and managed care is designed to keep health care more affordable. People who subscribe to managed care pay a set fee per month no matter what their medical needs are. Managed care organizations are also designed to help health organizations run more smoothly; providers get to spend more time with their patients thereby giving better quality care.
Some of the cons of managed care are that premiums have risen and continue to do so; this may result in a lower quality of care for patients. Sometimes patients lose the ability to choose their doctor; patients with full benefits have limited choice of providers and if they change jobs they might have to change doctors also. Medical information can be less confidential due to the increase in paperwork.
From a consumers perspective, the pros would include the consumer only has to pay a monthly premium plus the co-pay. The cons include less freedom to choose which provider the consumer would like to see.
Looking at managed care from the caregivers point of view, the pros of managed care include:
HMO-Pay the provider’s salary, the HMO provides office space, staff and administration. There is more stability, better hours and less office work for the caregiver. The disadvantages are that there is less independence, the provider can only see HMO patients, and the HMO monitors care and cost.
CAPITATION-This is where the provider is given a set amount per patient. The advantages of capitation are that the provider receives money whether treatments are needed or not. The disadvantages are that if a patient needs more... [continues]

Read full essay