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Regulating Health Care

To what degree should private sector insurance companies regulate managed care issues such as the approval of procedures, referrals, and other decisions?

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Please see response attached, as well as presented below. I hope this helps and take care.

Response:

Let' take a closer look at the following question:

1. To what degree should private sector insurance companies regulate managed care issues such as approval of procedures, referrals, and other decisions?

This is a controversial topic, so you will need to argue your position: either that private sector insurances should play a major role in regulating managed care issues such as approval of procedures, referrals, and other decisions, or not. However, on some level, indirect influence on managed care decisions seems inevitable. Who should regulate these decisions? The health care facility and health care professions seem to be the one's that should make these health treatment decisions, but these decisions are definably influenced by the ability of the patient to pay (and large proportion of Americans (68.1%) depend on private insurance for health costs - see statistics below).

Managed Care Plan provides health care through a defined network of primary care physicians and hospitals. In this system, decisions about paying for care are generally made at the front end, before the services are received. These decisions are made by the payer (private insurance company health plan or employer), who bears the financial risk. The health plan (e.g. private sector insurance company) or employer reimburses the health care providers in advance for services that are expected to be delivered. ...

Solution Summary

This solution discusses the degree to which private sector insurance companies regulate managed care issues such as the approval of procedures, referrals, and other decisions.

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