Managed Care: A Literature Review

Decent Essays
Managed care is a health insurance system designed to reduce the cost of health care while providing quality services to gain maximal outcomes (“Managed Care,” n.d.). According to (n.d.), under the managed care system, members receive care at reduced costs due to contracted agreements between state Medicare agencies and health care providers. While States are progressively using managed care for Medicaid beneficiaries, the available evidence concerning its effect on health care outcomes is mixed, with little consistent evidence to support its efficacy (Caswell & Long, 2015).
In a 2015 study, Caswell and Long investigated Medicaid managed care (MMC) enrollment rates and health care outcomes among non-elderly, non-disabled and disabled beneficiaries. The authors sought to expand on previous studies examining the effects of increasing MMC penetration on healthcare access, usage, and costs within and among different states. Surveys were conducted from 2006 to 2009 collecting data on enrollees’ access to health care, usage, expenditures, disability statuses, and demographics, as well as the yearly MMC penetration rates for each county. Data restrictions excluded
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“Managed care is generally intended to provide access to appropriate care in a timely, efficient, and cost-effective way by shifting the locus of care from higher cost settings to primary care,” (Caswell and Long, 2015). As the results of the study seemingly contradict the conventional beneficial theories associated with managed care, the authors conclude that the principle advantages of MMC could be administrative simplicity, and improving states’ yearly budget
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