Distinguish between managed care and health maintenance organizations as systems for paying for health care and controlling health care costs in the United States

Question

What will be an ideal response?

Answer 1

Health maintenance organizations (HMOs) were created in an effort to provide

workers with health coverage by keeping costs down. Health maintenance

organizations provide, for a set monthly fee, total care with an emphasis on prevention

to avoid costly treatment later. The doctors do not work on a fee-for-service basis, and

patients are encouraged to get regular checkups and to engage in good health practices

(exercise and eating properly). As long as patients use only the doctors and hospitals

that are affiliated with their HMO, they pay no fees, or only small co-payments, beyond

their insurance premiums. Managed care is another approach to controlling health care

costs in the United States. Managed care is any system of cost containment that

closely monitors and controls health care providers' decisions about medical

procedures, diagnostic tests, and other services that should be provided to patients.

Patients choose a primary-care physician from a list of participating doctors. When

patients need medical services, they must first contact the primary-care physician? if a

specialist is needed for treatment, the primary-care physician refers the patient to a

specialist who participates in the program. Doctors must get approval before they

perform certain procedures or admit a patient to a hospital? if they fail to obtain such

advance approval, the insurance company has the right to refuse to pay for the

treatment or hospital stay.