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    Managed Care and Quality

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    A Managed Care Organization (MCO) is a generic term used to refer to a managed care plan. The main purpose of an MCO is to provide the infrastructure for the delivery and administration of care within a managed care system. In other words, the MCO is an organization that arranges to deliver health care services without having to use insurance companies or third party administrators. One of the main goals is to provide quality care at reasonable prices. One tool used to do this is through a gatekeeper system. Gatekeeper is an informal, but widely used term that refers to a primary care physician (PCP) responsible for referrals or authorizations for non-emergency specialty care. The Gatekeeper is the provider of first contact. Gatekeeping refers to a method of coordinating and/or controlling utilization. This is a predominate feature of almost all HMOs.

    Take a position on whether or not you agree with the notion that a person is forced to see a PCP before being referred to a specialist. Does this practice impede quality care? Can the delay in seeing a specialist cause greater harm to a patient? Please provide references and a min of 250+ words.

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    Solution Preview

    Studies suggest that an increase in managed care controls are not associated with either a reduction in access to specialists nor worse health outcomes (1).

    With the increasing complexity of healthcare - more than 50 specialties, and many, many more sub-specialties, and the fragmentation inherent to our system, a patient may benefit from the services of his or her primary care physician (PCP) to assist in the coordination of ...

    Solution Summary

    This solution of 243 words takes a position on the issue of how managed care may impeded quality care through the use of primary care physicians as gatekeepers. References used are included.