Health Care Concepts - Essay Example

Introduction

Managed care represents a structure that assimilates the funding and delivery of appropriate healthcare by employing an all-inclusive set of services. The U.S. utilizes a private and competitive health insurance system that aids in developing managed care (Ash et al., 2017). Managed-care plans are forms of insurance that have contracts with healthcare providers to offer their members care at reduced costs. This essay assesses the different concepts of the three managed care plans.

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Health Maintenance Organization

Health Maintenance Organization (HMO) is an expensive form of managed medical care. Individuals who take-up the program pay fixed monthly premiums to allow individuals to co-pay small fees on visits and prescriptions. With the plan comes a list of doctors and hospitals, from which individuals can choose their primary care physicians (PCP). PCP offers general health and referrals to specialists (Falkson & Srinivasan, 2020).

Preferred Provider Organizations

Preferred provider organizations (PPOs) are similar to HMO with monthly premiums. However, unlike HMO, an individual is offered more choices on their provider selection. Where an individual needs to seek care outside their network, PPO covers their expenses. Thus, PPO will offer its members more choices, which gets viewed as better services; it is more expensive (Ellis & Zhu, 2016).

Point of Service

Point of Service (POS) limits choice; however, it offers a lower cost compared to PPO and HMO. The plan allows their members to choose a primary physician who becomes their point of service. The primary physician can offer referrals outside their network with limited cost coverage. POS plans require their members to keep track of their medical expenditures (Ellis & Zhu, 2016).

Conclusion

In conclusion, managed care entails organizing healthcare suppliers' processes to attain controlled healthcare costs and managed care quality. Managed-care plans involve healthcare insurance providers contracting healthcare providers to offer reduced care costs for their members. Managed care gets divided into health maintenance organizations, preferred provider organizations, and point of service.

References

Ash, A. S., Mick, E. O., Ellis, R. P., Kiefe, C. I., Allison, J. J., & Clark, M. A. (2017). Social determinants of health in managed care payment formulas. JAMA internal medicine, 177(10), 1424-1430. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5710209/

Ellis, R. P., & Zhu, W. (2016). Health plan type variations in spells of healthcaretreatment. American Journal of Health Economics, 2(4), 399-430.
https://www.mitpressjournals.org/doi/full/10.1162/AJHE_a_00056

Falkson, S. R., & Srinivasan, V. N. (2020). Health Maintenance Organization (HMO). In StatPearls [Internet]. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK554454/.