Written by Hassel Hamilton
University of Axia
Everyone knows what it is like being sick and cannot afford to see a doctor because
of high cost of healthcare well I suggest that we take a look into the mirror and see the
reflections of the Pros and cons of managed care , and traditional insurance before
Making a change .
According to (Wikipedia, 2009) managed care offers a variety of techniques that help
with unnecessary cost of healthcare through the different mechanisms and economic
incentives such as lower costly select forms, programs that are to review the medical
necessity of some services, control the cost of admission and the long stays in the
hospitals , helps increase beneficiary cost sharing, lower the cost of outpatient surgery , and
lower the cost of healthcare.
Managed care has a variety of techniques
Managed care helps to lower the cost of healthcare and improve the quality of care each
with its on specific reasons that falls under the category (Wikipedia, 2009) of integrated
delivery systems such as patient education, Disease management, case management,
wellness incentives and utilization management. Integrated delivery system is formed by
physicians and hospitals that are to suppose to help lower the cost of healthcare and
improve the quality of care. Patient education is to alter and improve behavior and health
status through prevention and health promotion. Disease management help lower the cost
of labor by minimizing the effect of chronic illness. Case management helps by
monitoring services. Wellness incentives help promote a better out look on employees
health, and enormous increases . utilization management helps to control the cost of
preadmissions , and long stay in the hospitals .
Manage care advantages and disadvantages
Health Maintenance Organization (HMO’s) is a low cost plan that has it
advantages such as Managed care allows individuals to have an option of care with
a (Daltons. J, 2007) “wide selections of physicians and hospitals” that are prescribed .
HMO’s helps to lower the cost of “premium health” ,but cost can become expensive
when going outside the HMO’s coverage to see other specialist they have ask for
permission of the HMO’s and the HMO’s has to refer the individual to another specialist
because the consumer is only allowed to be covered when seeing the prescribed doctors
and if the individuals go out of this coverage will be asked to pay for the full cost . In
addition primary care physician is responsible for total care.
Preferred Provider Organization (PPO’s) is unlike the HMO’s plan has it
advantages allows individuals to see a variety specialists of his or her choice, that
are covered by the PPO’s coverage, instead of having prescribed physicians. If he or
she is in need of a specialist that is not his or her primary care physician, he or she does
not have to have a referral or nor do you have report to primary care physician. PPO’s
has disadvantages as well as the HMO’s the cost of PPO’s is expensive and will not pay
for the full cost of coverage if any individual decides to go outside of its coverage .
Independent Practice Association (IPA) is unlike the HMO’s and PPO’s has it advantages
you are allowed to choose a doctor or hospital of your choice in which involves a fee-for-
service that is reimbursed from insurance companies.. The disadvantages are that
individuals have to pay for every visit, test , procedure, and healthcare services with an
out- of- pocket expense . In addition consumers may have to pay a (Wikipedia, 2009) “
higher co-payments or deductibles”.
Preferred Provider Organization (POS) has advantages...