Managed Care Research Paper

Managed care is any arrangement in health care in which an organization like HMO or

another type of doctor-hospital network or an insurance company acts as intermediate

with the individual that is seeking care and the physician. The intention of managed care

is to eliminate facilities and services that are no longer needed or useful and also to

reduce costs. In managed healthcare their insurance plans are very different from the fee-

for-service, or FFS, insurance plans. In the early 1970’s rapidly growing enrollment in

managed care health insurance plans has transformed the health insurance market in the

United States. In managed care plans they contract for lower prices from physicians and

hospitals and
For example if there is an improvement made in the diagnostic imaging field

meaning this could provide clearer, higher quality images this would lead to more

favorable surgery outcomes. Therefore the likelihood of a better surgical outcome may

result in more individuals electing to receive surgical treatment.

In the traditional fee-for-service method the doctors and hospitals got paid for each

service they performed. Under this service they were no limits on their treatment

decisions the doctors or hospitals could order as many tests as they wanted to and felt it

was necessary. The doctors and hospitals made a lot of money under this system because

they decided the prices that they would charge for the patients visit. A patient would not

always benefit from this service because their insurance companies would often pay a

percentage of the fees that were being charged. For example if the hospital charged $100

for a checkup but the insurance company felt that $80 was a fair price then the patient

would have to pay what was left which would be $20 until a certain deductible was