Purchase Solution

Managed Care and Quality

Not what you're looking for?

Ask Custom Question

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.

Purchase this Solution
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.

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 ...

Purchase this Solution
Free BrainMass Quizzes
Managed Care Organizations

This quiz will test the basics of managed care organizations. It is important to know how our health care delivery system operates through managed care.

Celiac Disease

This quiz will provide a brief introduction to Celiac Disease. Questions will focus on definitions and symptoms.

Vitals about a Patient's Vitals

Basic questions about blood pressure and measurements.

Test your health planning and program evaluation knowledge

Health planning and program evaluation is an important aspect of the Health Sciences' field. Organizations and communities must understand the needs of their audiences, and a way to obtain this datum is through proper design and assessment. This quiz will test your ability to understand the importance of planning and evaluation in the health sector.

Labor and Delivery

Do you know about the stages of delivery? Find out with this quiz!

View More Free Quizzes
Related BrainMass Solutions

  • Cost of Care in Managed Care Programs

    593753 Cost of Care in Managed Care Programs Is there consistency or direct correlation between the cost of care and its quality in managed care program?

  • Managed Care

    110979 Actual Results of Managed Care on the Health System Managed care was initially promoted as a means for improving coordination of care and quality of care and reducing wasteful spending.

  • Continuum of Managed Care Models

    528351 Continuum of Managed Care Models Describe how the continuum of managed care models helps to understand the level of control for access, quality, and costs for each type.

  • Managed care vs. traditional cost/reimbursement models

    Managed Care Models Traditional cost/reimbursement and managed care models present differences to all stakeholders in the access to care, quality and costs involved.

  • Managed Health Care

    Step 2 Next the physicians should be involved in utilization review and quality improvement programs. Managed care should involve physicians in both utilization review and quality improvement programs.

  • Quality Assurance in Managed Mental and Behavioral Health Care

    Quality Assurance in Managed Mental and Behavioral Health Care This solution discusses quality assurance in managed mental and behavioral health care.

  • The Future of Managed Care

    Describe what you see as the future of managed care. Base your assessment on a comparison to traditional healthcare delivery systems using cost, quality, and access to care.

  • Performance Management Project

    In 1979, the Group Health Association of America and the American Managed Care Review Association, the major trade associations of the managed care industry, founded the National Committee for Quality Assurance.

  • Advantages and Disadvantages to Managed Care

    Effects of Managed Care on Physician-Patient Relationships, Quality of Care, and the Ethical Practice of Medicine/ Retrieved fromArch Intern Med. 1998;158(15):1626-163 This solution discusses the greatest advantage/disadvantage to the managed care provider

View More Related Solutions