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Health Managed Care Plans

Prevent Sickness and Injury

Managed Care plans limit the choice of a recipient to selecting their own health service provider, but in return offer comprehensive services by designated professionals at a lower cost.

The ideology behind managed care plans is essentially that of preventative care and the nurturing of a healthy lifestyle commensurate with the recipients abilities and needs. Policy holders are routinely offered incentives to maintain their health, which is obviously of benefit to the recipient of health care insurance, but also serves to reduce the cost to the insurer of large groups of individuals over time.

For example, the incidence of smoking has plagued the health of countless individuals over the past few generations and is now a medically established danger to not only an individual's health but the health of the community, and an enormous expense to the health care sector.

Therefore incentives to give up smoking by participation in specific programs are often offered with a reimbursement of costs for the individual choosing to embark on such a path of health. Additionally, managed care plans are one of the only types of plans that will willingly cover the costs of immunizations and routine medical checks.

Commercial Juggernauts

Once they were made available in the 1970's individuals responded with great enthusiasm to managed care, and by the 1990's most Americans were subscribers to such a plan. In addition to diverse coverage and services, managed care plans often contract their own staff and medical facilities dedicated to providing health care to their policy holders.

Termed health maintenance organizations or HMO's, these large corporate medical facilities can procure the services of group practice associations or even employ individual physicians to meet their demand for health care.

If specialty care is found wanting within the group, the policy holder is able to obtain referrals to appropriate professionals who are able to provide the service, the main objective of HMO's being to preserve control and centrality in order to discharge health care in the most efficient commercially viable manner possible.

Latterly, some managed care plans have been made available in the form of Preferred Provider Organizations where an individual is able to choose a provider belonging to the organization, but in the event that they wish to seek their own provider, for an additional charge they are able to exercise this right.

In recognition of a patient's needs that lend themselves to being reliant on a well known physician, some managed care plans will allow the recipient to nominate a health care provider and with an adjustment of terms of cost within the policy, such as a higher coinsurance amount or higher deductible, will accept the individuals choice to seek care from their designated provider, but provide access to preferred providers as well.

Apart from the recipients behavior which managed care plans seek to control through financial incentives, these types of plans also seek to control the behavior of heath care suppliers by the same means. Studies have shown that higher quality care is delivered to a patient when security of employment and quality remuneration and conditions are made available to the professional health care provider.

The feature of coinsurance also serves to remind both practitioners and policy holders of the cost of health care, and therefore an unreasonable expending of resources is avoided. Such are the methodologies utilized by managed care plans to preserve resources and deliver effective health care services to their subscribers. 

 

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