Benefits & Disadvantages of Managed Health Care

Managed care is a big part of health care today, but the question is whether it is the best way to control health care costs. Sometimes it can be advantageous, while other times it can have disastrous consequences. We will look at both the advantages and disadvantages of managed health care.

Defining Managed Care

• Most people who have managed care health insurance don't even understand the concept or why they might be better or worse than ordinary insurance plans. Under managed care insurance, companies attempt to control the cost of health care for employers by introducing specific guidelines or protocols health care professionals must follow and improve the ways both employees and employers select their medical providers and facilities. The assumption is the plan will allow a financial accounting that shows the results of various medical treatments in both patient responses and quality of life issues. The belief is that a managed care system will allow both employers and employees to make better judgments concerning quality health care providers.

History

• Managed care plans were first organized during the 1920s but their origin is credited to non-profit organizations during the 1940s. Its growth was slow until health costs began to soar in the 1970s and 80s when employers began to see managed care as an alternative to high-priced health care options. The increase in competition within the health care industry led to the birth of profit-making organizations that offered new and innovative managed care techniques. At the same time, many states reorganized their Medicaid plans to accommodate managed care plans. Enrollments in managed care increased dramatically and by 1999 half of all doctors and over three-quarters of all insured families were part of some kind of managed care plan.

Advantages

• There are two major advantages that insurance companies see with managed care. The first is monetary. With a group of health care providers banding together, the focus is on providing health care that will save money for the employers that offer health insurance to their employees. By saving money on health insurance they can either pay less out of their own pockets or be able to afford to cover more of the cost of insurance for their employees.
  Quality of service is another issue that is part of the managed care plan. Insurance companies and employers feel they can assist their employees in the selection process by having a network of medical providers they have already evaluated by the insurance company. This network of providers has passed the evaluation process and has the credentials and experience the managed care plan analysts feel meet the needs of their subscribers.

Disadvantages

• Although advocates of managed care feel it is best for a patient to deal solely with one health care provider who will make a decision whether the patient needs to be treated by a specialist, some patients feel they are locked into using a doctor with whom they are not familiar. This is especially true if they change employers or the employer changes plans and their current physician does not participate in the new plan. This can mean extensive out of pocket expenses if the patient chooses a physician who is "out of network."
  Another problem some people have with managed care plans is this: for the sake of saving money, the primary care physicians often forgo necessary testing until a condition is out of control. They often prescribe over the counter medications for conditions that would respond better to prescription medications such as allergies and some bacterial infections.

Choose the Good Over the Bad

• One of the most important things to remember about managed care is you can save a great deal of money for yourself or your employees. Making good choices in the providers you choose will assure you receive the best of care from your primary care physician as well as the specialists within the network. Unfortunately, the PCP is limited in what decisions he can make --- often the patient must assume a more aggressive role and make certain the PCP knows all of his symptoms in order to determine whether more aggressive treatment is necessary.