Advantages and Disadvantages of Managed Care

Managed care, in terms of healthcare, means a person agrees to only visit certain doctors and specialists underneath their health care plan. In turn for this agreement, the costs are kept low by a managing company who oversees all health care interactions of their clients. The reason these costs are kept significantly lowers is because the company has contracts with particular healthcare providers and hospitals.

There are three different types of managed care plans that are available. These are Heal Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Point of Service plans (POS). Each is a little different from the other, but provide the same basic service, managed health care.

Advantages of Managed Care

Lower Cost
The main goal of managed care providers is to provide the absolute best quality care possible, for the least amount of money. This is a great benefit of these types of health care plans. This is accomplished through the contracts that are set up with doctors and hospitals.

Accredited Care
All of the doctors and health care providers that are contracted through managed care plans have to pass a very in depth accreditation process in order to be approved for their network of care providers. This further ensures the quality of care that is available.

Cheaper Prescriptions
Along with the initial visits, medications are also covered underneath these plans. This greatly reduces the cost of already expensive medications. For many, this is the main reason for appeal to these managed care plans. Some people need medications in order to live a healthy life, and many of these medications are ridiculously high priced.

Disadvantages of Managed Care

Restricted Care
Since you can only visit doctors that are in your managed care provider’s network, you are very limited as to who you can see. Many doctors are instantly out of your reach with these plans.

Strict Approval
Insurance companies are businesses, meaning their primary goal is to make a profit. Because of this, the things that they are willing to fully cover, or cover at all, is very strict. Many people with preexisting health conditions and problems are out of luck.

Referral Problems
It is not uncommon for a doctor to refer you a specialist when a problem is out of his scope of practice. They do not concern themselves with finding out if that doctor is in your care network, meaning you cannot go to see them, and if you do the cost will come fully out of pocket.

While many people criticize the quality of care and the ethical practice of managed care providers, the fact remains, they provide a great service to many people. Without health insurance even the most minor of illnesses can cause an incredible amount of financial stress.