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Managed care vs. traditional cost/reimbursement models

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What are the differences between managed care and traditional cost/reimbursement models? Use at least 2 published peer-reviewed journal articles from within the last 3 years related to the evaluation of the managed care model versus a fee-for-service approach. Summarize the results in consideration of costs, quality, and access to care in 2-3 pages.

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This solution discusses the differences between managed care and traditional cost/reimbursement models. It uses peer reviewed sources from last 3 years and summarizes results with consideration of costs, quality, and access to care. APA formatted references.

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Traditional Cost/Reimbursement vs. Managed Care Models

Traditional cost/reimbursement and managed care models present differences to all stakeholders in the access to care, quality and costs involved. Traditional cost/reimbursement models allow doctors and hospitals to be paid for each service they perform. There are no limits on their treatment decisions, allowing doctors to order as many tests as they feel necessary. Insured patients are reimbursed the amount that the insurance company feels appropriate, regardless of the amount billed. The patient pays the difference until a certain amount is reached. Managed care organizations are concerned with cost-effectiveness and saving money. To reduce costs, these organizations buy services in bulk, for many members at a time, thus securing lower prices. Managed care organizations reduce costs by limiting choices to the members, providing a list of preferred doctors and labs where tests can be performed. Managed care organizations control the process further by limiting doctors control of prescribing tests and certain medications. Different mandated care plans have different restrictions on choice. The impact of these models affects specific populations based upon their interaction with the system, in regards access to care, quality, and costs.

Choosing between managed care and traditional cost/ reimburse models affects specific populations differently. Graham, Kurtovich, Ivey, and Neuhauser (2010) point out the impact of the choice between the two models for seniors and people with disabilities. The authors utilized a ...

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  • BA, University of Southern California
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  • Ed.D, Boise State University
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