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Managed Care
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HCA/230
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Managed Care
Managed care is a way to provide healthcare to many who would not be able to afford it
through traditional insurance. Managed care was intended to utilize a network of doctors and
healthcare providers with a set cost to the consumer. Many people would say this would be a
great way for to have insurance, but some say it having the opposite effect on patient care. It
seems in today society everything is about the bottom line, instead of what’s best for the
consumer. So what is best for the consumer, tradition healthcare, or managed care? What are the
pro’s and con’s of managed care?
First off I will discuss the pros of managed care from a consumer and providers
perspective. If a consumer is looking at insurance from a financial prospective managed care
seems like the right choice. The reason about 93% of Americans chooses managed care over
traditional insurance is because it is affordable to no matter what his or her health may be (Axia,
2010). The consumer pays a set premium amount and then a co payment when visiting his
caregiver in the network. Managed care will cover all other expenses associated with his or hers
healthcare. With traditional insurance a person would have to pay a deductable and if the
expenses go over that set amount then the insurance company would pay 80% of the remaining
bill. Also with traditional insurance there is still on top of paying a deductable and the remaining
balance that was not covered, they still have a monthly premium.
The pro’s of managed care from the caregivers perspective is a mostly based on stability
of pay. With an HMO option the provider is paid a salary and provided a support staff, which
gives the doctor more time to spend with patients, better working hours and a shared patient load.
Capitation is when the provider receives a set amount per patient no matter what care is given.
This could be beneficial if the costs of care per patient are less than the amount set per patient.
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PPO advantages are that the provider can treat patients in the plan or outside the plan. The PPO
pays the provider a discounted rate and he or she is still able to remain in control of the practice.
For the provider managed care can relieve some of the administrative responsibility, provide a
steady income and a reasonable patient load (Axia, 2010).
Now, I will turn the attention to the cons from a patient’s perspective of managed care.
When a person first starts learning about managed care they may feel that finally there is an
answer to the healthcare crisis in America, but upon looking closer at the system is managed care
worth it. Many people believe that although the price is right the quality of care suffers.
Americans are in fear that with managed care trying to save money that many conditions are
undertreated. Another disadvantage of managed care is the paperwork, if all documents aren’t
correct the person could be denied bennifits. Managed care also does not give the patient many
options of providers. A patient must remain with caregivers in the network to receive bennifits
(Axia, 2010).
The cons of managed care from a caregiver’s point of view are of a different nature than
the patients. Many caregivers feel the pressure to stay within a budget, and if that budget is
exceeded could face punishment from the organization. Caregivers could lose control over the
running of his or hers practice with managed care. There is also a growing concern that
switching from caregiver to caregiver can compromise the patient- caregiver relationship.
Caregivers are also burdened by the amount of paperwork required by the organization which
takes away from the quality of care provided.
If I were a caregiver and I had to choose to take traditional insurance or managed care I
would pick traditional. I say this because for one I would not want to compromise they care I
give my patients because I was afraid of not getting paid. Also I am the type of person who
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wants the control of running my practice the way I see fit. If I knew a patient would bennifits
from a certain treatment, I would make sure that I aided that patient in getting the help her or she
needs. I would not want to be placed under a gag order and told I could not provide the best care
possible. Although for some the bottom line in life is money, but for me the bottom line is what
kind of care would I want?
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Reference page
Axia College of University of Phoenix. (2010). History and Current Issues. Retrieved December
11, 2010, from Axia College, Week One Reading, HCA/230Communication Skills for
The Health Care Professional Course Web site.

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