Managed Care of the U.S.

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Commonly managed care describes a continuum of arrangements that integrate the financing and delivery of health care. It encompasses many different arrangements with particular doctors, hospitals and other providers to deliver services that make up networks of health care plans. Most managed care organizations offer a wide array of benefit designs that include HMO products, preferred provider organizations, and direct access products that allow patients to self-refer to specialists. (Sekhri, 1997) In practice, there are three different big categories; HMO, POS and PPO. managed care encompasses a wide range of arrangements, some of which resemble discounted fee-for-service (e.g.) and others (e.g. some HMOs) using capitation and ‘‘gatekeepers’’ — primary care physicians serving as patients’ initial contacts for medical care and referrals — to manage patient care and authorize referrals.e A frequently cited managed care pioneer is Dr. Michael Shadid, who started a rural farmers' cooperative health plan in Elk City, Oklahoma in 1929. With help from the Oklahoma Farmers’ Union he succeeded in enrolling several hundred families and these members paid a predetermined fee and Dr. Shadid rendered his patient care (Tuft, 2005). This kind of alternative healthcare arrangement started among many communities across the nation in the 19th century. The goal was to help meet the healthcare needs among groups of people; workers and families in the lumber, mining, and railroad industries. Enrollees paid arranged fee to physicians who in return provided care under their terms of conditions. These prepaid group practices preceded the modern day’s Health Maintenance Organizations. Medical care cost in the US has risen steadily that mark up significant part of Gross Domestic Product. To manage the health care cost, many have switched to managed care that controls finance and health care delivery. There are many different types of managed care including preferred provider...
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