Last Updated on March 17, 2021 by Filip Poutintsev
A form of insurance of health where the members are provided with the facility of care of their health via the medical facilities and the providers of the care at a limited rate is known as the managed care plan.
This form of insurance binds the medical facilities and the providers of the health care in delivering their services at a reduced rate to their members via contracts. The degree of payment for medical care via this plan is dependent on the rules of the network.
There are about three kinds of managed care plans, and the cost for each of these plans depends on one’s flexibility of choices. Plans that offer higher flexibility cost more in comparison to the plans that confine one’s selections.
This health care form is the most basic form within the United States, where it can be accessed in three forms viz. point-of-sale care, Health Maintenance Organizations (HMO), or preferred provider organizations. Each plan has its own merits as well as demerits, and care must be taken for deciding which form to pick for your health care.
Regardless of the form, managed care plans are a topic of debate incorporating several advantages along with disadvantages that are to be discussed in the following section of this article. These plans deliver solutions to care of health for people anytime they desire to have a word with a provider of care and ensures the rendering of instant services.
However, there are several shortcomings to this facility, as in the absence of the insurance of health, free healthcare, or Universal health Care, these plans cost extremely high. All of the shortcomings of this plan along with the reasons for its huge application within the United States are presented in brief in the following section for easing your decision in whether or not to adopt this plan for your health care.
Advantages of Managed Care Plans
Managed-care plans come with immense benefits, which are listed as below:
1. Instant Solution to Health Care
One of the noteworthy merits of the managed care plans is the provision for the families to acquire instant contact with a doctor or a provider of health care. This facility might cost you a bit but is highly beneficial for ensuring instant solutions to any problem of health at the patient’s satisfaction.
2. Unites Families
For the management of the care of health, there is a requirement for establishing a relationship between the provider and the patient. In case of the absence of this information, the providers of care aren’t able to make a precise diagnosis. Hence, within a managed care plan, one can choose a provider of care for themselves and their family, leading to a single doctor for the entire family.
3. Confirmed Care
Providers of care within the networks of the managed care are required to pass several endorsement procedures for ensuring the provision of the care for the patient as effectually as possible. Regardless of the experience of the service providers, this plan mandates the provision of peace of mind for the patient for making them believe in the system.
4. Reduced Cost
The managed care plans’ prime motive is to limit the expenses of health faced by the families on accessing the services of health care when required. The providers of care and services usually offer a discount while in the managed care plan, assuming the stay of the family in that network to be heightened, leading to the provision of care of health at a reduced rate.
5. Simplified Management of Prescription
Several networks of managed care, operate with the agencies of pharmaceutical for guarantying the affordability and availability of the required prescriptions for the needed ones. Through this plan, the process of refill is simplified, leading to the reduction of cost in certain cases.
Disadvantages of Managed Care Plans
Regardless of such mesmerizing merits, managed care plans are disadvantageous in the following factors:
1. Loss of Privacy
On a managed care plan being the stress point for a system of health care, there is the presence of a greater risk of the occurrence of the issue of privacy while managing the information of the patient. Within this system, there is no assurance of the privacy of a patient’s data once it gets reviewed.
2. Limited Care
Being poor and residing in a system with the plan of managed care leads to the limitation in the feasibility of the choices one gets. Most individuals in this condition are required to take care of the emergency rooms, leading to the limitation in the availability of care.
3. Treated as Merchandise
In these kinds of systems, providers of health usually treat the patients more as merchandise than as a person. As per the article, about 5000 general community, non-federal, and short-term hospitals functioning within the United States are found to have posted about 64.4 billion dollars of cumulative profit for 2012 that was about 21% higher than the previous year.
4. Longer Wait Time
This system is found to offer people with healthcare for routine situations with extended waiting time for seeing a doctor. Regardless of the availability of the emergency employment facilities open for the needed health challenges, most of the time, one can consult their common practitioner after weeks or months.
5. Forced Advocacy
A managed care system, regardless of it being centralized or a system of free-market, generally demands referrals in case of the patient needing advanced care for treating their health problems. The truthfulness of this drawback is especially in cases of accessing a provider of health care exterior to their general network.
Summarizing, managed care plans grant the members with the guaranteed facility of immediate and cheap health care, and ensures the instant solution of their health-related problems through the provision of communication with the health care personnel anytime required. Also, within this plan, one can seek out care for their health and manage the prescriptions much easily.
However, within this plan, the privacy of the member patient is lost and one is required to wait longer for acquiring the desired health care. Also, people, rather than the doctors in this plan are forced to advocate for their health, where people have treated nothing more than merchandise.
Hence, this plan does benefit people with the requirement of immediate consultation and care, but I don’t think it to be greater than other services of health that offer much more and take much less than this system.