Pros and Cons of Managed Care

Care Some of the pros for managed care are; Preventive care — HMOs pay for programs, they are set up and are intended at keeping one healthy (yearly checkups, gym memberships, etc. )The idea is, so they won’t have to pay for more costly services when and if one gets sick.

Lower premiums — Because there are limits set as to which doctors one can see and when one can see them, HMOs charge a premium and usually they are lower premiums.Prescriptions — As part of their precautionary retreat, most prescriptions are covered by HMOs for a co-payment that also can be very low. Fewer unnecessary procedures —doctors are given financial incentives from HMOs , to provide only needed care, so doctors are less likely to order costly test or surgeries that one does not need. Limited paperwork — While healthcare professionals and facilities have more paperwork, under managed care, HMO members usually only has to show their membership card and pay a very low co-payment.Some of the cons for managed are; Limited doctor groups — To keep financial burdens down, HMOs tell one which doctors’ one can see, including specialized fields. Restricted coverage — one cannot expect care on command because ones primary-care physician must justify the need based on what benefits ones plan covers. Prior approval needed — If one would like to see a specialized doctor or go to the emergency room, one would need permission from their main physician.

Possibility of under treatment — Because of the incentives given doctors to limit care, the doctor may try to hold back on good care management he would give. Compromised privacy — HMOs use patient records to keep an eye on doctors’ performance and efficiency, so particulars of one’s medical history could be seen by other people. Getting medical care used to be thought of as trouble-free. One would go to the physician of their choice, get great care and their health insurance would cover the cost of seeing the physician and cover tests needed.These networks should stand for better earth care for less money. But as they work hard to keep out of pocket expenses down, the scary tales it causes are frightening: “drive-by” mastectomies, when women are not allowed facility stays after harrowing breast removal; As network bureaucrats who deny a claim for coverage to the emergency room when heart attacks turn out to be indigestion; doctors who get year-end payoffs to give constraining care and don’t communicate to patients about better costly treatments.Those against managed care aren’t so kind.

It can be said that the system that once commended physicians for working too much for the patient now, are given an incentive for doing a lot less. “The incentive now is to put bounds on care,” says (Dr. Donald Hanscom, a Beverly gynecologist. ) “Everything is money. “After a decade of wining and dining the public with lower premiums and a wider spectrum of benefits, the inexperienced period for managed care is noticeably over. Those opposed are uneasy by the idea of unethically abuse.They are apprehensive members, many are not getting the care needed, the specialists they want, or the coverage one should get to have, especially in health urgencies.

They also are concerned about issues that come up that have plagued the healthcare system elsewhere in the nation, such as stifling guidelines set up that keep doctors from suggesting more costly treatment choices. Although they say their far reaching goal is to provide a greater healthcare, the business has brought forth an unwelcoming talk that seems to challenge that.Patients who choose a doctor that does not participate in a “The” network, either at their own expense or with restricted coverage by the network, are considered “leakage. ” Doctors who go against the networks system to get better treatment for their patients sometimes risk being blackballed out of and the network. It’s reassuring to know that some networks are doing a good job, but lawmakers are dealing with a weary opposition that isn’t frightened by what the nation thinks. Those up on the hill have responded with a charge of state and national bills pointed at bringing in a booming healthcare industry that’s pretty much free-for-all.For their part, the networks don’t see what the entire objection is about.

They say productiveness and peoples request will keep their guidelines just and within ones means. “The networks are trying not only for cost, but also for class and peoples’ satisfaction. It’s a patron service industry when you get right down to it. The network points to their absolute success in bringing down costs and keeping the mass of network enrollees happy. Each month people across the nation join a network, so it’s plain that, Network care is here to stay in one shape or another.Those against and those rooting for that of managed care agree that the existence of unconstrained health care on demand is declining. As health care costs push very high yearly, some say it’s time for all to comprehend that the medical healthcare industry has financial restrictions just like any other industry.

“People have been brought up to believe that health care is an entitlement,” says (Jeanne Holland, executive director of Northeast Physicians-Hospital Organization) at Beverly Hospital. They think ‘Life, liberty, the pursuit of happiness and health care on demand. ‘ Consumers need to change their thinking. “Resources http://ask. reference. com/related/History+of+Managed+Care? o=102545&qsrc=121&l=dir, Retrieved, October 26, 2010 http://www. ecnnews.

com/hlth/manintro. htm, Retrieved, October 26, 2010 http://ezinearticles. com/? Health-Insurance-Types, Retrieved, October 26, 2010 http://www. senioranswers. org/Pages/prosandcons. htm, Retrieved, October 26, 2010

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