Managed Care Delivery Model Analysis
The managed care delivery model was intended to decrease unneeded health care costs, by controlling the level of service along with the type of service that was being provided. This model came in a response to the rocket costs of the unrestricted fee-for-service plans in the 1980s. (PBS.org) Managed care plans are a type of health insurance. There are several ways the managed care model is expressed one particular way is the Health Maintenance Organization or better known as HMO. HMOs have their own network of doctors, hospitals and other health care providers who have agreed to accept a payment plan at a certain level of services they provide. With HMO, you would have to pick a Primary Care Physician within the local approved network where that doctor can coordinate any additional care you might need. If you need a specialist, a referral would be needed within the HMO network. HMOs usually have lower monthly premiums, but out of network health care professionals are not typically covered by the insurance.
…show more content…
Another managed care model is the Preferred Provider Organization or PPO.
This is similar to the HMO, it offers a network of doctors, hospitals and other health care providers at a certain rate. The PPO plan gives more flexibility on health care needs. You do not need a Primary Care Physician, and you can go to any specialist without a referral. You can go to any health care professional in or out of network. If you stay in your network you will have smaller copays,and will be fully covered. If you go outside your network you will have higher out-of-pocket costs and run the chance of not being fully covered. PPOs are going to have higher monthly premiums and there will be an annual deductible that has to be
met. There are advantages and disadvantages to the managed care model. The main advantage of managed health care is the low costs associated with them without sacrificing the quality. On the other hand the disadvantage of the managed care model is that you may not be satisfied with the care that is received from the provider. But getting another opinion from another professional outside your network would out-of-pocket costs higher.
Sekhri, N. K. (2000). Managed care: the US experience. Retrieved from http://www.who.int/bulletin/archives/78(6)830.pdf
(n.d.). Managed Care. Retrieved from http://www.pbs.org/healthcarecrisis/managedcare.html
Managed Care: MedlinePlus. (2017). Retrieved from https://medlineplus.gov/managedcare.html
Another managed care model is the Preferred Provider Organization or PPO.
This is similar to the HMO, it offers a network of doctors, hospitals and other health care providers at a certain rate. The PPO plan gives more flexibility on health care needs. You do not need a Primary Care Physician, and you can go to any specialist without a referral. You can go to any health care professional in or out of network. If you stay in your network you will have smaller copays,and will be fully covered. If you go outside your network you will have higher out-of-pocket costs and run the chance of not being fully covered. PPOs are going to have higher monthly premiums and there will be an annual deductible that has to be
met. There are advantages and disadvantages to the managed care model. The main advantage of managed health care is the low costs associated with them without sacrificing the quality. On the other hand the disadvantage of the managed care model is that you may not be satisfied with the care that is received from the provider. But getting another opinion from another professional outside your network would out-of-pocket costs higher.
Sekhri, N. K. (2000). Managed care: the US experience. Retrieved from http://www.who.int/bulletin/archives/78(6)830.pdf
(n.d.). Managed Care. Retrieved from http://www.pbs.org/healthcarecrisis/managedcare.html
Managed Care: MedlinePlus. (2017). Retrieved from https://medlineplus.gov/managedcare.html