Managed Care Essay

900 Words 4 Pages
Managed care is simply a system that delivers health care to a specific population purchased through health insurance plans. Practitioners and providers manage the use of health care services and cost by providing effective diagnosis and treatment, appropriate use of inpatient and outpatients facilities, population-based planning, health promotion and education, and disease prevention. Managed care uses a “gatekeeper” system, where patients or beneficiaries are assigned a Primary Care Physician (PCP), who they see initially for all medical care. The PCP acts as a gatekeeper by initiating referrals to specialists when required and approving inpatient admissions. Managed care was seen across communities in America as early as the 19th …show more content…
Managed care’s tremendous impact on medicine has focused on preventive health care, introduced outcomes measurement, evidence based medicine, utilization controls, and cost accountability to deliver high quality healthcare. At the same time, managed care has increased administrative overhead for providers, restricted vendor choices, and occasionally interfered with treatment protocols creating new problems in the healthcare setting. Virk (2007) suggests that managed care has become the backbone of the U.S. healthcare system and with the currently rising healthcare costs, critics have are again questioning the effectiveness of the managed care model. The decline of managed care in the United States appears at its highest point of acceptance as managed care plans competing in the healthcare market adopted characteristics of traditional insurance (Lagoe, Aspling, & Westert, 2005). As profitability became a tenet of managed care plans, premiums were increased passing a higher proportion of healthcare expenses to consumers. Managed care plans started catering more to consumer preferences in order to expand market share which decreased continuity of care and regulation of utilization controls, making managed care plans align more closely indemnity plans and preferred provider

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