Managed healthcare


In healthcare, clinical decisions are of prime importance. The medical team decides the mode of treatment depending on the medical case. However, there is increasing interest in the evidence on which decisions regarding the safety and efficacy of the healthcare system is based. This increases the need to have a standard management to care for the patients suffering from common conditions.

With the transformation of medical practice in the 20th century in USA there was an emphasis on the corporate management of health care. This has led to the origin of managed health care.

Within managed health care, standard care is provided to patients experiencing common conditions and a set of services and interventions are defined for managing such conditions. Managed care is an external party managing the medical care of the patients in addition to the medical team. They are just like a third party, generally an insurance company who influences the clinical decision making process for the person registered with them as a member. The whole idea of having such facility is to provide financial support to the members and make savings based on provision of cost effective care.

Managed health care insurance plans are designed to provide medical care at affordable costs. There are certain criteria that the members have to meet before getting enrolled. There are a set of guidelines that need to be followed as a part of managed health care plan. The major types of managed healthcare insurance plans are

  •          Health Maintenance Organizations (HMOs)
  •          Preferred Provider Organizations (PPOs)
  •          Point of Service (POSs)

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