A definition of managed health care and a discussion about the importance of educating the public about their options.
Written in 2006; 6,587 words; 12 sources; MLA; $ 151.95
Paper Summary:
This paper defined managed care as the effort to coordinate, rationalize, and channel the use of services to achieve desired access, service and outcomes while controlling costs. It then explains that risk-based managed care are organizations which provide or contract to provide health care in broad/specified areas for a defined population for a fixed, prepaid price. Various strategies are used to control costs and this is accomplished by offering a broad range of services at least the areas of hospitalization, physician care, various types of ancillary care and/or medications. The paper explains the importance of presenting the benefits in advance, along with payments expected from the covered individual or member, so that the person can make an educated decision.
From the Paper:
"Health care expenses frequently are too expensive for the average individual to pay as they go, but are suitable for health insurance coverage. Managed care provides either the service directly or contracts to provide them. This differs from conventional health insurance, where the insurer would underwrite the coverage, but not become involved the delivery of services. Managed care providers take a financial risk for part or all of the cost of service. There are three levels of risk. First, full risk whereby the provider accepts all of the financial risk for providing services, as well as all profits and losses. Secondly, partial risks where the provider accepts a portion of the risk. Third, no direct risk to the provider, but receive incentives to control cost. The last one is found in various case-managed primary care arrangements."
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