Managed Care

Managed Care is a healthcare delivery system designed to manage the cost and quality of healthcare services. The system is characterized by a network of healthcare providers who agree to supply services to members at lower costs. Managed care plans are typically contracted with health insurance companies, government programs, or self-insured employers who bear the risk of healthcare costs.

Overview

Managed care plans are designed to control healthcare costs by coordinating and controlling the delivery of health services. The plans are typically contracted with a network of healthcare providers who agree to supply services to members at lower costs. These providers may include doctors, hospitals, and other healthcare professionals and facilities.

Types of Managed Care

There are several types of managed care plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans.

Health Maintenance Organizations (HMOs)

Health Maintenance Organizations (HMOs) are a type of managed care plan that requires members to select a primary care physician (PCP) who coordinates their care. Members must receive care from providers within the HMO's network, except in emergencies.

Preferred Provider Organizations (PPOs)

Preferred Provider Organizations (PPOs) are a type of managed care plan that allows members to receive care from any provider. However, members pay less if they use providers within the PPO's network.

Point of Service (POS) Plans

Point of Service (POS) plans are a type of managed care plan that combines features of HMOs and PPOs. Members may choose to receive care from providers within or outside the plan's network, but they pay less if they use network providers and receive a referral from their PCP.

Criticisms

Managed care has been criticized for limiting patient choice and for its focus on cost containment over quality of care. Critics argue that the system incentivizes providers to limit care, potentially leading to poorer health outcomes.

See Also

• Healthcare in the United States
• Health insurance in the United States
• Healthcare reform in the United States

Managed Care Resources
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