17 Mega Pros and Cons of Managed Care

Managed care is used to describe a group of activities intended to reduce the cost of providing health facilities to people. They make up for the plan’s network. Health Maintenance Organization usually pays for care within the network.

They function as an insurance company and assume the risks. They arrange to provide for health care mainly through contracts with the providers. They manage the utilization of health care services. The payment methods are capitation and discounted.

pros and cons of managed care

Pros of Managed Care

  1. Easier to manage prescription

Many networks work hand in hand with pharmaceutical agencies to ensure that they provide the required prescription to their clients. The services are usually available and affordable to those who may need them.

  1. There is a certain guarantee

The patients are taken care of effectively so that the accreditation process can be passed to the company.

  1. It unites families

Families are able to be united through the network as there is a good relationship that develops between the service provider and the patient. This gives doctors an easy time as they will be able to get all the needed information from the patient and it becomes easier to diagnose the ailment.

  1. Information moves quickly

Within the network, the information is able to move quickly and this may be of great assistance in case the patient needs the services of a specialist.

  1. Easy to make referrals

When a patient is to be referred, it becomes easier as there is a network hence attended to quickly within the required time-saving lives of many individuals.

  1. Low cost

Those who are accessed to the services, are provided to them at low cost and this makes it easy for them to access the services whenever they need them.

  1. Include patients having multiple options for coverage

Patients can be covered for multiple options and this makes it easier for clients to go for it as they may be covered over multiple options.

  1. They provide quality services

The service providers ensure that the services that are provided to the patients are of high quality so that they can gain good accreditation.

  1. It focuses on preventive care

As treating a disease is very costly, the network provides preventive measures so that the disease cannot move to its worse condition where the patient will be required to use a lot of money to treat it.

Cons of Managed Care

  1. Long wait times for busy networks

Some networks are very busy and this can make the patient wait for long before being attended to. This discourages many as the disease can grow into its worse condition before the patient is attended to.

  1. Privacy is not withheld

The network needs a summary of the patient’s medical report so that they may use it for treatment and payment methods. This makes the patient give all the information concerning his or her health so that it can be used.

  1. Providing unreasonable services

The service providers give unreasonable services to the patients so that it can maximize the billing that can be presented to the insurance.

  1. People must advocate for themselves

In case the patient needs to be referred outside the network, he or she should follow up to ensure that she is out of network procedures for the billing not to be put on the insurance.

  1. They operate under rigid rules

It is not easy for the patient to choose his or her own doctor when operating under the network. Even if the services provided to the patient do not make him or her satisfied, he cannot be allowed to complain over that so that he may be given another service provider.

  1. It limits care access to those who do not have insurance cover

When someone is not covered, it becomes difficult for him or her to be attended to and this limits those who are poor as they cannot pay for the services.

  1. Restrictions on where to get services and referrals

The patients under this program are restricted where to get the services from and in case of referrals they are also restricted regardless of not getting the right services.

  1. Turns people into commodities

People are made to be commodities whereby they can be done to any unnecessary services provided they can have the evidence that the test was done and the billing will be made and ask the insurance company to pay the money.

Summary

Managed care units have good services to offer only if the disadvantages can be managed in order for the patients to receive the right services and at the required time. By doing this it will be able to meet its objectives of starting it hence attracting many clients to join the network.

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