Benefits Of Managed Care

Healthcare in the United States is very expensive. When a patient goes to see his doctor in hopes that he will get the necessary treatment. All doctors are patients advocates and care providers. It seems logic because the patients don’t have the necessary medical knowledge. With the pay-for-service system, the patient would request treatment and the doctor would deliver the best care for the patient. Sometimes the doctor may recommend a procedure that is more expensive that the alternative treatment available for the patient. The doctor in this role plays a bauble role. He recommends the patient to get the service that he provides. It is hard to know if the doctor acts on behalf of patient’s best interest or for his own financial gain.
When managed care is involved the situation is very different. According to Henderson (2015), “Managed care uses various reimbursement methods with the goal to shift some of the financial risks to the provider. Shifting risk

discourages overuse of services, that use of expensive technology, brand names drugs, referrals to specialists” (p. 216). Henderson (2015) also states that” managed care forces providers to have a more cost-effective practice. If a cheaper care option is available the provider is encouraged and rewarded for choosing it” (p. 217). Primary doctors are also the gatekeepers, that must determine if the patient needs a specialty treatment and refer patient accordingly.
Managed care affects the way a doctor treats its patients and the way patients view their doctor and the medical care they are receiving.

Managed care puts providers in a tough position to deliver the necessary care. If the medical provider was free to perform any procedure he thought is necessary under fee-for-service payment, he may get penalized for doing that under managed care guidelines. Managed care doesn’t allow the medical providers to recommend expensive procedures, but instead in encourages cheaper alternatives. The patients that use to pay-for-service system feel that they don’t get the best care that they deserve. Managed care places restrictions on certain services and discourages the overuse of medical care, which was encouraged by the pay-for-service system. Henderson mentions that “Managed care is unpopular among health care providers, and that managed care challenges their clinical independence and income. When providers are not happy with a plan their patients will mimic the

criticism.
Managed care in contrast to the fee-for-service care is more cost efficient. The reduction of hospital visits, encouragement of use the generic drugs, alternative procedures, encouragement to practice preventive care result in fewer hospital visits and not overuse the medical care. Henderson brings up many studies that support this claim. He states that, “Managed care plans had 10 to 40 percent costs per enrollee than conventional health plans” (p. 219). Other research states that “HMO provide competitive care to fee-for-service care at savings of 10 to 15 percent (p. 219). But the most important research according to Henderson concluded that “25 percent of Americans enrolled in managed care plans would reduce annual healthcare spending of $57 billion. One-third of the US population enrolled in managed care plans will result in $85 billion in savings annually” (p. 219). Since the US spends nearly 17 percent of GDP on healthcare it would be great to be able to save some money and hopefully reduce the healthcare cost. It might make healthcare affordable for everyone.