Managed Health Care Considerations

A managed care system is a form of insurance in which the insurer works with specific healthcare providers, rather than covering healthcare across the board.

Advantages

• The major advantage of a managed care plan is that it can keep costs per person low. This is because it is essentially buying healthcare in bulk--by providing a large number of clients to certain doctors and hospitals, these doctors and hospitals don't have to charge each individual as much.

Types

• There are three types of managed care plans--Health Maintenance Organizations, Preferred Provider Organizations and Point of Service plans. The first of these has a set group of healthcare providers available, the second has a preferred, cheaper group but will still fund a portion of outside providers, and the third lets you pay the same amount no matter whom you see. These are arranged in order from cheapest to most expensive.

Problems

• The major problem with managed care plans is that it is often difficult to get emergency room treatment--some plans either bill people large amounts afterward or make them go through a phone-in diagnostic procedure before they go to the emergency room, which is time-consuming during a time when most people don't need their time consumed.