What-is-the-role-of-managed-care-What-three-goals-are-present-in-mana/,What is the role of managed care?

Has using a managed care approach been successful? ( Use Resources)

Managed care is a form of health care provision that has the primary aim of controlling for costs, use of resources and quality of service. It coordinates both the funding and provision of medical care to administer cost while guaranteeing right healthcare for patients. MCOs get this done through developing provider panels, setting payment premiums, and employing mainly the prior authorization method, case management, and utilization review.

 Managed care can be viewed as having three principle objectives:

 Cost Containment:

 Dominant approach to organisational and financing of care and seeking to cut overall health cost by obtaining a better price for services, restraining use of service and encouraging preventive care to prevent the necessity of further costly services.

 Quality Improvement:

 Another tangible goal includes the enhancement of the care quality through the use of guidelines, measurements as well as giving incentives to ensure that the providers subscribe to the best practices. The specific objectives of current managed care plans sometimes consist of quality assurance programs and mechanisms.

 Access to Care:

 According to managed care, access to the required healthcare services is attained through making networks of available providers that patients can attend. These networks are developed in a way that there is smooth and appropriate delivery of health services, with more focused on primary and preventive care.

 Success of Managed Care

 The success of managed care has been mixed:

 Positive Outcomes:

 There are objectively recognized advantages of managed care, for example, regarding cost containment, which has been manifested in the 1990s when the majority of healthcare facilities implemented it. It has also expanded the ability to get preventive and acute/chronic illness treatment due to the increase focus on the primary care and standardization of early-detection measures.

 Challenges:

 However, some critics believed that managed care decreased the patient autonomy, decreased quality, and presented burdens on the provider. A patient may not have access to specialists or get treatment that may not be recognized or paid by the health insurers.

 In conclusion, managed care has made good results in attaining its goals of cost containment and some aspects of the quality and access to care but it has its own challenges that should be deal with on a constant basis (drug. com) (CDC).