Managed Care Plans are leading forms of providing high quality health care services across United States. They were established in 1920s and successfully adopted by non-profit organizations in 1940s. Between 1970s and 1980s, health care costs in United States were rapidly increasing. As a result, employers opted to utilize Managed Care Plans rather than the highly priced healthcare plans. This further increased competition across the health care industry facilitating the development of profit making health care organizations. They provided newly innovated managed care services and techniques across health care facilities in the country. Consequently, the Medicaid plans were reorganized to provide room for Managed Care Plans. By 1999, Managed Care Plans had been adopted by more than fifty percent doctors, insurance companies, and families (O’Connell, 2011).
Forms and Advantages of Managed Care Plans
According to Cyrene (2014), there are three major forms of Managed Care Plans. They include Healthcare Maintenance Organizations (HMOs), Point of Service Plans (POS), and Preferred Provider Organizations (PPO). They all provide similar benefits.
Foremost, they are beneficial to employers, health care providers, and insurance agencies providing health care covers. The benefits can be attributed to various reasons. They include providing high quality health care services. More so, Managed Care Plans are associated with low costs. Thus, they are accessible and affordable to majority of persons across various income levels. As a result, they attract employers seeking to offer employees medical care services and benefits mainly associated with insurance covers. More so, Managed Care Plans do not charge exorbitant fees. Thus, health care providers are able to provide medical services to several persons across various health care facilities (Brenda, 2014).
The Managed Care Plans dictate that professionals ought to be highly skilled, qualified, and experienced based on their credentials. This rule was developed to ensure health care professionals and physicians provide high quality medical and health care services to members of the public. This boosts confidence among members of the public seeking healthcare services as they believe and trust they are in good, safe, and experienced hands of primary care physicians and professionals. As a result, the public achieves and sustains peace of mind. Managed Care Plans also reduce wastes while providing safe and efficient procedural treatments such as needless tests. Managed Care Plans ensure physicians conduct necessary procedures without harming clients, financial and non financial resources as well as the environment (Malcolm & Bronwyn, 2014).
Disadvantages of Managed Care Plans
According to Cyrene (2014), Managed Care Plans can be rigid in relation to rules applied by health care providers. For example, if HMOs provide unsatisfying medical services, a client is denied an opportunity to seek advice from another physician on behalf of the plan. They dictate a client ought to pay for the consultation fees. Thus, Managed Care Plans can provide sub-standardized medical services in order to save money at the expense of health care qualities (Malcolm & Bronwyn, 2014).
Members of the public complain physicians and medical professionals are sometimes forced to skip conducting health care tests due to the rigid rules. Complains filed against Managed Care Plans claim the physicians and medical professionals employed are inexperienced, less skilled or educated. This is because they can be hired and remunerated at low costs saving the plans money. More complains assert some health care professionals conduct unnecessary tests and treatments. This is a strategy to earn extra revenues beyond the profits acquired through Managed Care Plans (James, 2009).
Managed Care Plans are mainly strict against SOPs. Acquiring approvals from insurance companies is challenging coupled with long periods of waiting and lengthy treatment procedures. The inconveniences can further affect health care providers and persons seeking medical services coupled with busy schedules. It is also challenging for Managed Care Plans to provide privacy. This is because treatment procedures, tests conducted, and medical conditions are summarized and provided to the company without protecting the client’s details for privacy purposes (James, 2009).
Managed Care Plans provide healthcare services at reduced costs. Thus, they save clients, employees and insurance companies money. More so, they provide an opportunity for more persons to access, afford, and acquire medical services. However, persons should always ensure they seek health care services from educated, licensed, skilled, qualified, and experienced healthcare providers. Managed Care Plans are important within the health care system. They are aligned to the government’s vision in providing healthcare services to all citizens at affordable costs. Thus, clients, employees and insurance companies should continue adopting Managed Care Plans. Brenda Coxe advises citizens to choose the good over bad in relation to Managed Care Plans. This translates to focusing on the pros rather than the cons (Brenda, 2014).
The author’s advice to continue adopting Managed Care Plans is applicable. This is because they provide healthcare services equally among citizens in United States without discriminating based on race, income levels, religion, and social clusters among other factors. Thus, people seeking and providing healthcare services should continue supporting Managed Care Plans. In order to improve Managed Care Plans, the following innovative and governance systems can be applied. Foremost, a system should be innovated aimed at protecting and providing privacy for members. Secondly, a governance system ought to be adopted to ensure doctors do not conduct unnecessary tests in order to earn extra revenues. The system should also assist in reducing wastes. Lastly, a financial system ought to be adopted capable of accounting health care costs. It should be innovated to encourage the Managed Care Plans to provide services while saving money without comprising on health care quality and standards.
Brenda, C. (2014). Benefits and Disadvantages of Managed Health Care, Health Care Demand Media Inc.
Cyrene, U. (2014). Advantages and Disadvantages of Managed Health Care, Health Care and Auto Insurance Report.
James, R. K. (2009). The Pros and Cons of Managed Health Care, Inland Newspaper Daily Reports, 909(1): 386-3826.
Malcolm, T., & Bronwyn, H. (2014). What are the Pros and Cons of Managed Care?, Conjecture Corporation.
O’Connell, S. (2011).Medicaid Monitoring: An Overview of Managed Care for the Children, Families, Health and Human Services Interim Committee.