The Managed Care System in the U.S.

Running Head : The Managed Care System in the U .S

The Managed Care System in the U .S

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PPO , HMO and POS are often summarized with the term `Managed Care Managed care is a good health outcome relatively than medical intervention . Not every visit to a doctor is required nor is every test conducted , every medication prescribed , or every placement in an intensive care unit going to produce an effective outcome . Ideally medicine must be ruled by rationality and efficiency in the choice and accomplishment of

evaluations and treatments . This means that the variability between providers not simply should be but can be eliminated , and the only factors that must make a difference in deciding who to treat and what treatment to accept is the nature of the patient 's disease or injury

An HMO is a health insurer that presumes responsibility for providing comprehensive health services to a properly enrolled population in return for a predetermined payment . HMOs come in several shapes and varieties . The traditional "group " and "staff " model HMOs still lean to contract with or employ an exclusive provider network . The newer "network " or "IPA " models contract with individual providers or groups of providers who retain similar contractual relationships with other health plans

HMOs lean to "lock-in " patients . That is , unless they are eager to pick up the entire bill for going outside of the contracted network , HMO enrollees receive services simply from contracted or employed providers Out-of-pocket costs to enrolled members are usually very low , usually either 5 or 10 a visit . But , as many consumers object to the lock-in feature , over seventy five percent of HMOs now offer a point-of-service (POS ) option , which gives patients the option of looking for the care of a doctor outside of the HMO network for a price

HMOs "point of service (POS ) option , which permits HMO members to go out of network whenever they choose and pay a particular co-insurance amount out of their own pocket . In its use of financial incentives for patients to obtain care in the designated network of providers , the POS option resembles a PPO . The major difference is that the in-network care normally takes place in an HMO 's cost-control environment , together with the use of gatekeepers and capped payments to physicians

Patients joining an HMO entered a health care . For some , mainly the young and healthy and those who had grown up in these programs , the alternative was pleasing . But for several individuals who had ties to personal physicians or who were more comfortable visiting customary solo or small group practices , care in a "clinic " was improper and they resisted the change

A PPO is a much looser arrangement than an HMO and bears more semblances to traditional insurance , mainly in using fee-for-service payment to physicians . Patients can see any provider in the network , and pay simply a modest portion of provider charges . PPO members can also see providers not in the network , but for a considerably higher out-of-pocket...