The Rapid Growth of Managed Care

The rapid growth of managed care is the response to limited financial resources and the demand for healthcare services to be affordable. Economic viability is a crucial aspect of health care. Managed care plans were developed to provided health care services, but also to be a method to collect payment for services. There are different types of managed care plans. For example, health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service (POS) plans. For brevity of this paper the HMO managed care system will be discussed along with the relevance of the role of the advance practitioner practicing in HMO setting.

The 1970's need for primary care settings to curtail and control cost for employee benefits caused the development of the group practice model or also known as a HMO (Anderson & O’Grady, 2009, p. 380). HMO is a type of a managed care system created in an effort to provide health care to a large group of people. Its purpose is to provide health care services at a lower cost and often at a fixed cost. The HMO plan is based on obtaining authorized health care services by utilizing "in-network" providers. This meant the plan under that HMO will only cover the physicians and services which are authorized. If, for some reason, a specialist or extended service, such as admission to the hospital or rehabilitation service may not be authorized the "out-of-network "service must be approved by the HMO provider. The advantage to "in-net-work" and limiting health care service under a plan is control cost. The cost under these plans are none to a small percentage of "out-of-pocket" expense at the time of service. The disadvantage of this type of plan is only "in-network" physicians or serv...

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...09, p. 384). NPs are able to see patients with the minor health problems. Therefore, freeing up physicians to attend to the more serious ill patients.

References

Anderson, A. R., & O’Grady, E. T. (2009). The Primary Care Nurse Practitioner. In A. B. Hamric, J. A. Spross, & C. M. Hanson (Eds.), Advanced Practice Nursing an Integrative Approach (4th ed., pp. 380-402). St. Louis MO: Saunders.

Aspen . (2008, September 1). Managed Care. Managed Care Outlook, 21, 1-6. Retrieved from http://web.ebscohost.com.ezproxy.graceland.edu

Hit Where it hurts why HMO profits are shrinking fast. (1997, October 27, 1997). Business Week, 42 - 43. Retrieved from http://web.ebscohost.com.ezproxy.gracedland.edu

Stevens, A. B., & Sanghi, S. (2010). Emerging frontiers in healthcare research and delivery. Clinical Medicine & Research, 3, 176 -178. doi: 10.3121/cmr.2010.974