This paper will provide a comprehensive overview of managed care, primarily on the advantages and disadvantages of managed care organizations.
Over the decades, the United States’ healthcare system has been experiencing challenges. In general, the cost and quality of care has always been considered as the most critical factors that influence healthcare sustainability in the United States and the world, as a whole. As a result, a series of value-based payment reforms have been introduced. For instance, the Affordable Care Act (ACA) of 2010 introduced payment and delivery system reforms.
From a critical perspective, the reforms introduced by the ACA have addressed the long-standing problems which have been posing enormous hindrances to the development of the U.S. healthcare system. Above all, it has enhanced managed care through consolidating care, as well as, addressing the problem of unsustainable costs and uneven quality of care. However, managed care seems to exhibit some drawbacks too.
Contents
Introduction
Overview of Managed Care Organizations
Managed Care Principles
Managed Care Compared to Conventional Health Care
Types of Managed Care and what They Are
Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPOs)
Point-of-Service (POS) Plans
Advantages of Managed Care
Decreased Cost
Accredited Care
Large In-Network Providers
Cheaper Prescriptions
Disadvantages of Managed Care
Restricted Care
Out-Of-Network Providers
Lack of Specialty Care
Increased Cost of Unapproved Care
No Access for the Uninsured
Strict Approval Processes
Referral Issues
Summary
References
- Citar trabajo
- Patrick Kimuyu (Autor), 2018, The Role of Managed Care Organizations within the Healthcare Industry, Múnich, GRIN Verlag, https://www.grin.com/document/388764
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