Purchase Solution

Managed care vs. traditional cost/reimbursement models

Not what you're looking for?

Ask Custom Question

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.

Purchase this Solution
Solution Summary

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.

Solution Preview

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 ...

Solution provided by:
Sally Baldwin, Ed.D
Education
  • BA, University of Southern California
  • MSS, United States Sports Academy
  • Ed.D, Boise State University
Recent Feedback
  • "Thk u"
  • "Thank you!:)"
  • "Thank you!:)"
  • "Thank you!:)"
  • "Thank you!:)"
Purchase this Solution
Free BrainMass Quizzes
Cost Concepts: Analyzing Costs in Managerial Accounting

This quiz gives students the opportunity to assess their knowledge of cost concepts used in managerial accounting such as opportunity costs, marginal costs, relevant costs and the benefits and relationships that derive from them.

Marketing Research and Forecasting

The following quiz will assess your ability to identify steps in the marketing research process. Understanding this information will provide fundamental knowledge related to marketing research.

Accounting: Statement of Cash flows

This quiz tests your knowledge of the components of the statements of cash flows and the methods used to determine cash flows.

Business Ethics Awareness Strategy

This quiz is designed to assess your current ability for determining the characteristics of ethical behavior. It is essential that leaders, managers, and employees are able to distinguish between positive and negative ethical behavior. The quicker you assess a person's ethical tendency, the awareness empowers you to develop a strategy on how to interact with them.

Basics of corporate finance

These questions will test you on your knowledge of finance.

View More Free Quizzes
Related BrainMass Solutions

  • The Future of Managed Care

    These factors would fall under quality and access to care. However, the doctors did rate impact on cost control as a positive factor of managed care in comparison to traditional / cost reimbursement models.

  • Characteristics of various popular managed care models

    511055 Characteristics of various popular managed care models compared with traditional indemnity insurance plans Outline the characteristics of various popular managed care models (i.e., HMO staff model, HMO group model, IPA, PPO, EPO, etc.) and compare

  • Evolution of health care delivery models

    quality of care offered by traditional fee-for-service providers.

  • Prospective Payment (DRG) and Managed Care

    In one study about the perceptions about managed care cost containment strategies, for example, Exhibit 2 shows how American adults perceive four different cost containment strategies commonly used by health plans: 1.

  • PFFS vs HMO Comparison: Describe and Compare Fee-for-Service Plans and Managed Care Plans

    However, you are almost always paying the entire cost of your medical care upfront, and then receiving a reimbursement from your insurance company. This solution discusses three different structures for managed care plans in 236 words.

  • Managed Care

    The operation decisions that Healing Hands Hospital makes must take the managed care reimbursement issues into consideration. Mr.

  • Origins of Managed Care System in the U.S.

    During the 1980s and 90s: Managed care expanded rapidly in the United States. In private health insurance, a major shift occurred from traditional indemnity insurance to managed care plans in many markets.

  • Cost-plus and Cost-based Reimbursement System

    41009 Cost-plus vs. Cost-based Reimbursement System Why was the cost-plus or cost-based system not an effective reimbursement system? 1. Why was the cost-plus or cost-based system not an effective reimbursement system?

  • Healthcare finances reimbursement

    The prospective-payment, cost reimbursement, discounted-charge and flat-rate reimbursement is examined.

View More Related Solutions