Advantages and Disadvantages of Managed Health Care Author:    Posted under: Health InsuranceHealth Insurance questions answeredHealth Insurance Types


Managed health care is probably the leading form of health care in the United States. Whether as a benefit from employers or enrolled independently, those who are fortunate enough to have health insurance, are apt to be getting it from a managed health care provider.

The most common forms of managed care providers are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Point-of-Service Plans (POS). They all come with their various pros and cons.

Advantages

Obviously, the first and main advantage of managed health care is the lower costs associated with them. The aim of managed care is to keep health care costs down without sacrificing quality, and they have accomplished this by contracting health care providers and referring these to their enrolled members to avail of services and procedures at a discounted rate. This type of health care is most attractive for employers who seek to provide medical care benefits to their employees without having to shoulder exorbitant fees.

Another advantage seen by many in managed care is the network of health care providers that are readily available to them. These health professionals and facilities have gone through an accreditation process; their credentials and experiences carefully analyzed and have been deemed as having an innate capacity to serve members with quality care. This is important to members in that it gives them peace of mind to know that they are in good hands when a medical need drives them to consult with their primary care physician.

Disadvantages

The other side of the coin when it comes to managed care for some members is the rigidity of rules concerning the choice of health care providers, which is especially true for HMOs. In some cases, a member may not be fully satisfied with the care that is given by a primary care physician and would want to consult with another who is not included in the network available through their managed care provider. The only recourse would be to do so and pay the expense in full out-of-pocket. There are those who complain and speculate that in order to save money, their managed health care provider contract inexperienced, less-educated doctors and health professionals. Others have reported that for the sake of saving money, their primary care physicians skip on the tests necessary for members to go through in order for their conditions to be properly diagnosed. On the opposite side of this spectrum are those who complain that their primary care physicians make them go through unnecessary treatments and tests for their condition in order for them to make more money.

One more criticism against this type of health care is the strictness of SOPs that have to be followed. For instance, the need to obtain approval from the insurance provider before any treatments is commenced, as well as the type and length of treatments. Many also lament the long waiting periods to get appointments, the inconvenient locations for network providers’ offices and clinics, or that the available times for appointment do not fit their busy schedules.

Often, members also dislike the loss of privacy since the managed care company receives summaries with details of their medical conditions and treatments availed.

Make sure that you consult with a managed health care professional in order to be more informed about the advantages and disadvantages of managed health care. Go over each detail in order to get satisfactory confirmations and clarifications on any issue you might have so that you can make an informed decision.

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