Differences Between Managed Care Organizations & Universal Health Care

In the world of health care, managed care and universal care represent contending philosophies and approaches. Managed care means medical treatment is limited by guidelines set down by a private insurance carrier. With universal care, everyone has access to some form of medical treatment; public agencies set fees, collect premiums and process payments. Although many industrialized nations in Europe, as well as Canada, have mandated universal care, the managed care system remains dominant in the United States.

Managed Care Systems

• In a managed care arrangement, an insurance carrier provides its customers with a roster of physicians belonging to a network. The patient must select doctors from this roster, or pay more for treatment by a physician who is out of the network. In addition, certain treatments (such as surgeries) must be pre-approved by the carrier, who will not reimburse hospitals or doctors for unauthorized treatment (with the exception of medical emergencies).

Universal Health Care

• In a universal health care system, medical treatment is open to all, and there are no exclusive networks of physicians or facilities. Universal health care is managed by public agencies, which set reimbursement amounts for physicians as well as premiums charged to the public that support the system. Specialized or non-emergency treatment is still subject to review and approval by these public agencies.

Cost Savings

• Supporters of universal health care claim that such a system would save on administrative costs and the profit-driven fee structure of private insurers, which has given rise to expensive medical care and unaffordable insurance premiums. They also claim that universal access would improve overall public health, thus bringing about cost savings. No longer would the uninsured allow injuries and diseases to go untreated or seek out treatment in emergency rooms, the most costly form of health care.

Managed Care and the Private Sector

• Managed-care supporters believe that private insurance carriers guarantee the highest standards of care, and that public agencies would be a more inefficient and costly way of delivering medical treatment. They also believe that public agencies set up to administer universal-care systems would interfere in the doctor/patient relationship by imposing unacceptable limitations and conditions on treatment.