Pros and Cons of Managed Care Essay Example

health maintenance organization.

The health maintenance organization collects a sum of money each month to provide care to the individual from Medicare. The individual can only see physicians that are approved by the health maintenance organization.?

The disadvantages of managed care plans include:

• Services are limited based upon what the payer agrees to pay.

For example, employers will usually outline the number of visits or the amount of money they will pay for certain types of procedures.Medicare beneficiaries are, theoretically, entitled to the same benefits that Medicare provides. However, the review for "medical necessity" is more highly scrutinized and services are usually more limited in managed care.

• Individuals may have to change physicians since all physicians do not participate in all managed care plans and many physicians will only take a limited number of patients with a specific managed care organization.

The patient has NO coverage if they seek medical care from providers outside of the HMO providers.

• Benefits are usually more limited than those in an indemnity plan -- number of therapy visits, days in the hospital, etc.
• Some managed care plans are "risk contracts". The providers share the risk of caring for the individual.
• Most plans use generic drugs that have a 20% tolerance for the bioequivalence to name brand drugs. Certain drugs, usually name-brand drugs, may not be covered under this plan.
• Specialist care and sub-specialty care may not be available through the managed care plan, because these physicians may not participate in managed care plan.
• The patient has no freedom of choice as to which providers he seeks care.

The patient has no freedom of choice if there are several treatment options available from which to

choose. The patient has no freedom of choice as to where the services are rendered. As a caregiver, which plan I would prefer would depend quite a lot on my financial situation. If my budget allowed, I would go with the traditional insurance as there seems to be more independence and input on physicians, hospitalizations and medications.

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2. Doherty, E. (2008). Managed Care and Patients Rights. Retrieved October 26, 2008, from http://www. senioranswers. org/Pages/prosandcons. htm
3. Graham, M. (2006, June 21). Managed Care Pros and Cons. Retrieved October 26, 2008, from http://ezinearticles. com/? Managed-Care-Pros-and-Cons&id=225175