Preview

Pros and Cons of Managed Care

Good Essays
Open Document
Open Document
965 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Pros and Cons of Managed Care
Pros and Cons of Managed Care Some of the pros for managed care are; Preventive care — HMOs pay for programs, they are set up and are intended at keeping one healthy (yearly checkups, gym memberships, etc.)The idea is, so they won 't have to pay for more costly services when and if one gets sick. Lower premiums — Because there are limits set as to which doctors one can see and when one can see them, HMOs charge a premium and usually they are lower premiums. Prescriptions — As part of their precautionary retreat, most prescriptions are covered by HMOs for a co-payment that also can be very low. Fewer unnecessary procedures —doctors are given financial incentives from HMOs , to provide only needed care, so doctors are less likely to order costly test or surgeries that one does not need. Limited paperwork — While healthcare professionals and facilities have more paperwork, under managed care, HMO members usually only has to show their membership card and pay a very low co-payment. Some of the cons for managed are; Limited doctor groups — To keep financial burdens down, HMOs tell one which doctors’ one can see, including specialized fields. Restricted coverage — one cannot expect care on command because ones primary-care physician must justify the need based on what benefits ones plan covers. Prior approval needed — If one would like to see a specialized doctor or go to the emergency room, one would need permission from their main physician. Possibility of under treatment — Because of the incentives given doctors to limit care, the doctor may try to hold back on good care management he would give. Compromised privacy — HMOs use patient records to keep an eye on doctors ' performance and efficiency, so particulars of one’s medical history could be seen by other people.

Getting medical care used to be thought of as trouble-free. One would go to the physician of their choice, get great care and their health insurance would cover the cost of seeing the

You May Also Find These Documents Helpful

  • Good Essays

    Hcr 230 Week 1 Assignment

    • 473 Words
    • 2 Pages

    With HMO plans there is a list of providers that the patient can only go to, if they go to a doctor that is not in the list of providers they will have to pay extra. The only way that a patient should see a provider out of the network is if it is an emergency. HMO’s have an annual premium and a copayment that is due at the time of service. The main services the HMO’s cover is preventive and wellness checks and disease management. However, in order for complete coverage the enrollees must see a doctor that offers an HMO plan. The providers manage the care and referrals are required, low payments, ad this plan does cover preventative care.…

    • 473 Words
    • 2 Pages
    Good Essays
  • Better Essays

    The purpose of a managed care organization is to coordinate the costs and delivery of health care. A managed care organization oversees money spent on labor, technology, and facilities such as physician offices and hospitals. A type of managed care organization is a Health Maintenance Organization (HMO). A HMO “provides medical care for all its enrollees in return for a fixed annual fee per enrollee” (University of Phoenix, 2010, Key Terms and Concepts Section). An HMO tightly oversees the use of health care services thereby reducing costs and controlling utilization. For example, HMO’s…

    • 1187 Words
    • 5 Pages
    Better Essays
  • Powerful Essays

    Pros And Cons Of Obamacare

    • 1325 Words
    • 6 Pages

    establish a working healthcare plan, and succeeded. Now that this plan is on the verge of…

    • 1325 Words
    • 6 Pages
    Powerful Essays
  • Satisfactory Essays

    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.…

    • 394 Words
    • 2 Pages
    Satisfactory Essays
  • Powerful Essays

    Health maintenance organizations (HMOs) provide a simple supplemental health maintenance and medical services to members who pay in advance a fixed periodic fee is set without regard to the cost or type of services received ("Health Maintenance Organization Plans, " 2012).Plus diagnostic and treatment services, involving hospitalization, and surgery, an HMO often offers additional services, such as dental, mental, and eye care, and prescription drugs. The advantage of health maintenance organizations is this type of medical care annual premiums are less expensive the cost of care is distributed between the members.…

    • 1448 Words
    • 6 Pages
    Powerful Essays
  • Good Essays

    The pros of managed care are since the patient is limited to a specific caregiver the premium is lower. The patient only pays a monthly payment and a co-payment. The cons of managed care are that the patients are not allowed to see the doctor of their choice unless the doctor is in their network. The consumers perspective the pros and cons of managed care. The pros from the consumers perspective would be only paying monthly payments that is at a fixed rate. The other would be paying a small co-payment every time they see a doctor. The cons of managed care from a consumers perspective would be that they cannot see the doctor of their choice. The caregiver has to be affiliated with the managed care organization. The pros and cons from a caregivers perspective. The pros would be stability, fewer administrative duties, and better working hours. The cons would be less independence, and possibly a decrease in the income. There are more pros and cons these are just a few of them. From a caregivers perspective they would rather the patient have traditional insurance. The reason for this is because the caregiver is losing money by the patient having managed care. Caregivers get a percentage of the money when they see a patient with traditional insurance. Then there is also more stability and less working hours for the caregiver with managed care. It would be like flipping a coin for the caregiver what would they rather have more money or more time to spend with their family. The consumers perspective it would be in their best interest to have one of the managed care options (HMO,PPO). The reason for this answer is because for the most part most consumers…

    • 394 Words
    • 2 Pages
    Good Essays
  • Good Essays

    Managed care has been formed since the 1930 and evolved over the last ten years. Since the evolving of managed care there are three types of managed care plans. People that are enrolled in private health insurance are subscribed to a type of managed care plan. There are many differences between the three types of managed care plans and they also have similarities. The involvement of managed care plans are between the insurer and the selected network of health care providers, and the policyholder’s financial incentive that are used by the providers in the network. There are precise measures for choosing a managed care plan and conventional procedures to acquire quality care (Types of Insurance, 2010).…

    • 686 Words
    • 3 Pages
    Good Essays
  • Good Essays

    Obamacare Pros And Cons

    • 1470 Words
    • 6 Pages

    Obamacare, or what is formally known as the Patient Protection and Affordable Care Act, is federal legislation that was signed into law on March 23, 2010 by present Barak Obama. The act aims to reform national healthcare and give more people than before access to affordable healthcare. The overall goal of the act is to cover all persons regardless of their conditions or other factors. The passing of Obamacare has led to much conflict in the government and throughout the nation. In particular, recently the act has been the root of heated disagreements and government unrest among the Democrats and Republicans.…

    • 1470 Words
    • 6 Pages
    Good Essays
  • Good Essays

    The “Affordable Care Act of 2010” also known as “Obamacare” or “Health Care Reform Act of 2010” is a universal healthcare plan that was designed to allow Americans to be able to get quality health insurance that people would be able to afford, and to cut U.S health care spending down as well. Many Americans debated about whether or not it was beneficial for everyone or just certain people, so there are many advantage and disadvantages for Americas due to this reform.…

    • 970 Words
    • 4 Pages
    Good Essays
  • Good Essays

    Presently in the United States there are several different health care plans and the decision to accept Managed Health care plans become difficult. Managed care is the most utilized form of health insurance in the United States for it provides cost that is efficient versus paying for services rendered in one lump sum. However like everything in life, there are pros and cons to consider when it comes to managed care versus traditional insurance.…

    • 785 Words
    • 4 Pages
    Good Essays
  • Better Essays

    Evolution of Managed Care

    • 1519 Words
    • 7 Pages

    References: Davis, K., Collins, K., & Morris, C. (2006). Managed Care: Promise and Concerns. Retrieved on August 25, 2010, from http://content.healthaffairs.org/cgi/reprint/13/4/178.pdf…

    • 1519 Words
    • 7 Pages
    Better Essays
  • Good Essays

    Obamacare Pros And Cons

    • 773 Words
    • 4 Pages

    Obamacare is the current form of healthcare that our country uses, and it is one of the worst forms of healthcare that has ever been came up with. It is a terrible system that has been a failure since it was first installed as a government mandate that is required for citizens to have. It has a long list of problems that i can only really scratch the surface of in this essay. If you are a Republican, you probably are already against Obamacare; if you are a democrat, you are all for it most likely and can’t understand what's the big deal with it and why everybody hates it so much, but that's where i come in. Obamacare needs to be changed because it is bad, it has failed, it has problems, and why President Trump is going to get rid…

    • 773 Words
    • 4 Pages
    Good Essays
  • Satisfactory Essays

    group model

    • 601 Words
    • 3 Pages

    What appeals to physicians that work with staff model HMOs are salaried employees. One of the major benefits in staff model HMO, the salary is guaranteed, work hours are fairly regular. A practice administrator handles the business aspect this leaves the physicians free to do what they do best take care of his or her patients. Also staff model HMOs are convenient to patient care, such as labs, and radiology facilities and other types of diagnostic equipment. Physicians that are in staff model HMOs have more control over health care delivery.…

    • 601 Words
    • 3 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Health effects to consider that directly effect those who are 65 years and older are…

    • 739 Words
    • 3 Pages
    Satisfactory Essays
  • Good Essays

    Each and every managed care plan has both advantages and disadvantages that essentially need to be considered.…

    • 435 Words
    • 2 Pages
    Good Essays

Related Topics