What Are The Three Types Of Managed Care

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Financing and Structuring Health Care Dana Marie Doty Dr. Queensberry Health Services Organization- HSA500 January 29, 2012 The three main types of health in the United States are voluntary, social and welfare medicine. The three methods for categorizing health insurance in the United States are principle insurance vehicles that provide benefits associated with ill health, by the type of organization sponsoring the coverage and funding mechanism. The three types of managed care plans are Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) and Point-of-Service (POS). The three types of managed care plans can have both pros and cons. The Medicare and Medicaid programs have been impacted by managed…show more content…
Benefits include the use of a wide range of providers, the members’ share of the cost is reduced, and they are not forcing their beneficiaries to limit their provider choices or change their behaviors if they do not want to (Williams & Torrens, 2008). A con would be if the members do go outside of their preferred group they will pay higher coinsurance rates on discounted maximum allowances per services (Williams & Torrens). Another type of managed care plan is the Health Maintenance Organizations (HMO). For HMO the health plan benefits because it is able to limit its financial exposure by prepaying the provider group a fixed amount per member per month for taking care of the enrolled population (Williams & Torrens). The provider organizations are able to plan on more financially stable and long-term (Williams & Torrens). Patient benefits because there are usually small deductibles, if any, and low or no copayments for each class of service (Williams & Torrens). A con would be that HMO depends on an individual choosing to sign up with one particular group of physicians (Williams & Torrens). Point-of-Service (POS) combines elements of both HMOs and PPOs (this would be the benefit). A con of this plan would be that if the member chooses to receive care outside of the HMO provider group, then the beneficiary is exposed to higher cost sharing in the form of deductibles and copayments/coinsurance (Williams &
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