Healthcare Infrastructure Term Paper

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managed care be handled through private insurance providers.

MANAGED CARE

Should managed care be handled through private insurance companies?

Should managed care be handled through private insurance companies?

Managed Care is defined as " a health care plan, such as health maintenance organization (HMO), that "manages or controls costs by monitoring how medical professionals treat patients, limiting referrals to expensive specialists and requiring preauthorization for hospital care and other services to hold costs down." ("Triggers, caps, mandates: decoding the health care debate," 1994.) Managed care is now offered by all types of health insurance providers. The term includes health maintenance organizations (HMOs) that combine insurance with direct delivery of care and the preferred provider organizations (PPOs) that offer discounted medical bills if certain providers are used. In some cases, In many states, Medicaid coverage is now provided through private managed care organizations that have contracts with the state.
Thus people insured by Medicaid, as well as people in private employer-based group plans or those who are shopping for insurance on their own are being persuaded, urged, or even pushed to change from traditional fee-for-service insurance plans to an HMO (Hinson-Smith, 1999).

Managed competition through private provices is not universal health insurance; it will not cover a single uninsured American. A the Congressional Budget Office reported, scant evidence exists that managed competition can control soaring health care costs.….....

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