Managed Care Organizations Essay

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Managed Care Organization A managed care organization is a collection of clinics, doctors, hospitals, pharmacies and other healthcare providers who come together to offer health care to persons who are sign up for the services. In many cases, managed care organizations operate and are referred to as networks of health care providers. Managed care organizations are comprised of health care experts from different fields who come under an agreement to offer health care services to members. Once a member signs up, all their heath care needs are covered by the managed care organizations. Access to care outside the organization is restricted. Members under managed care organizations are usually assigned a primary care physician (PCP) who is the …show more content…

PCPs limit the access that members have to other sections of the network. In many cases, PCPs are overstretched as they treat even conditions that they have no expertise in order to keep costs down. Sending patients out to see other specialists increases the health care cost thus managed care organizations aim to keep referrals as low as possible. Another measure enacted by managed care organizations to control costs is limiting the amount of services a member can access. First, managed care organizations control the type of drugs that members get by offering only specific drugs that are in line with cost control measures. This means that pharmacies in the network might not offer drugs deemed to be expensive or unfriendly to the demands of the organization. Secondly, organizations limit the doctors that members can have access to. If one’s personal doctor is not in the list of doctors provided by the organization, a member is forced to switch by choosing one from the organization’s listed doctors. Managed care organizations also control costs by limiting the number of days a member is admitted in the hospital. Doctors are encouraged to discharge patients faster in order to reduce care costs. One of the advantages of enhancing cost control measures is that members are encouraged to change lifestyle habits that are detrimental to their health. For example, by encouraging members to quit smoking, engage in regular

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