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Sample Research Paper on Fee-for-service and Managed Health Care Plans

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Sample Research Paper on Fee-for-service and Managed Health Care Plans

Fee-for-service (FFS) can be described as a form of payment where services are unpackaged and paid for disjointedly. In regard to health care, it motivates doctors to afford more treatments since payment is reliant on the quantity as opposed to quality of care. Managed health care, on the other hand, is a healthcare arrangement whereby patients agree to see only certain physicians and health centers, and in which the cost of treatment is supervised by a managing firm. Despite their differences, FFS and managed care plans share some common aspects. For example, the two forms of plans cover a broad range of medical, surgical, and infirmary services (Martocchio, 2014). Also both plans cover prescription medicines and partially cover for dentists as well as other providers.

One of the differences among the two plans is the method used for payment. With FFS, once the yearly deductible amount is paid, a patient is asked to pay the doctor’s bill up front. Later, the patient submits a claim to be refunded a certain percentage of the amount which is usually 80 percent (Martocchio, 2014).  However, under managed care, patients are charged a $15 co-payment when they see a physician but it is the physician’s task to file the necessary formalities with the managed-care arrangement. The other difference is the quality and qualification of doctors whereby under FFS, qualifications will differ from one doctor to the other. Patients are responsible for checking physician’s credentials and for making sure they are receiving appropriate treatment once they are under a doctor’s care (Starr, 2013). Under managed care, the company takes on some of the responsibility of establishing whether doctors are competent when it asks them to join the plan. The other difference relates to the Scope of Periodic Checkups whereby with FFS, periodic check-ups do not incorporate cancer screening analysis like mammograms (Martino, Elliott, Haviland, Saliba, Burkhart, & Kanouse, 2015). However, under managed-care, the intermittent check-up by a primary-care doctor is paid for by the system and may be accompanied by reminders to get customary precautionary screening tests, which are covered as well.
























Martino, S. C., Elliott, M. N., Haviland, A. M., Saliba, D., Burkhart, Q., & Kanouse, D. E. (2015). Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee‐for‐Service. Health Services Research.

Martocchio, J. J. (2014). Employee benefits: A primer for human resources professionals (5th ed.). New York, NY: McGraw-Hill Irwin.

Starr, S. R. (2013, November). Navigating managed care: Assessing quality of services reported by patients with disabilities, transitioned from Medicaid fee-for-service (FFS) into a large urban Medicaid managed care plan. In 141st APHA Annual Meeting (November 2-November 6, 2013). APHA.

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