Pros and Cons of Healthcare

Topics: Managed care, Health maintenance organization, Preferred provider organization Pages: 6 (999 words) Published: March 16, 2009
Pros and Cons of Managed care

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 .

Managed care

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...
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