Managed Care: Benefits and Challenges
Managed care is a health care delivery system that provides cost-effective health care services to individuals and groups through a network of contracted providers. It is designed to improve efficiency and quality of care while controlling costs. Managed care has become increasingly popular in recent years as health care costs have increased and employers seek ways to reduce their health care costs. This article will discuss the benefits and challenges of managed care.
Benefits of Managed Care
Managed care can provide several benefits to its participants. One of the primary benefits is cost savings. Managed care plans often have lower premiums and out-of-pocket costs for consumers than traditional health insurance plans. Additionally, managed care plans can provide more comprehensive coverage than traditional health insurance plans. This includes preventive care services, which can help reduce the cost of future health care services.
Another benefit of managed care is improved quality of care. Managed care plans use networks of contracted providers who must meet certain standards of care. This can help ensure that members receive quality care. Additionally, managed care plans often employ utilization management techniques, such as prior authorization and case management, to ensure that members receive the most appropriate care at the lowest cost.
Finally, managed care plans often provide members with access to health care services that may not be available through traditional health insurance plans. These services can include mental health care, substance abuse treatment, home health care, and long-term care.
Challenges of Managed Care
While managed care plans can provide numerous benefits, they also present some challenges. One of the primary challenges is a lack of provider choice. Managed care plans typically limit members to a network of contracted providers. This can make it difficult for members to access a provider of their choice. Additionally, managed care plans often require members to obtain prior authorization for certain services. This can create delays in care.
Another challenge of managed care is the risk of underutilization. Managed care plans may use utilization management techniques to reduce costs, but this can lead to a decreased use of needed services and an increase in health care costs in the long run. Finally, managed care plans may require members to pay out-of-pocket costs, such as copayments and coinsurance, for certain services. This can be a financial burden for some members.
Conclusion
Managed care is a popular health care delivery system that can provide numerous benefits, including cost savings, improved quality of care, and access to additional services. However, it also presents some challenges, such as a lack of provider choice, delays in care, and the risk of underutilization. It is important for individuals to understand the benefits and challenges of managed care before making a decision about their health care coverage.
References
American Medical Association. (2020). Managed care: What is managed care? Retrieved from https://www.ama-assn.org/delivering-care/managed-care/what-managed-care
Kronick, R., & McDonough, J. (2014). Benefits and challenges of managed care in the United States. Health Services Research, 49(3), 1092-1108. doi: 10.1111/1475-6773.12187
National Institute for Health Care Management (NIHCM). (2017). Managed care basics. Retrieved from https://www.nihcm.org/managed-care-basics/