Care Coverage and Inequalities in the Education System
Traditional Care Coverage vs. Managed Care Coverage
Traditional care coverage is also known as Fee-for-service (FFS). Under this model, the patient pays for services that are itemized in the Invoice. The physicians gain an incentive to offer more treatments as payment depends on the quantity of care and not the quality of care. In the health insurance and healthcare sectors, traditional care coverage happens when physicians and other caregivers get a fee for each service like laboratory tests, office visit, procedure and other healthcare services. After providing services, the patient makes payments retrospectively. Traditional health coverage enables the patients to choose a healthcare provider, including a favorite hospital or doctor. The services rendered are paid for by the patient and then submits the bill to the insurance firm for reimbursement of the percentage it agreed to the insurer for the patient (Kongstvedt, 2012).
There are different managed care plans though they share some common features. All managed care plans tend to monitor the financing of healthcare offered to members. In addition, they are concerned saving money or cost effectiveness. By purchasing services in bulk for a bunch of patients at the same time, managed care plans receive lower prices from hospitals and doctors. Compared to traditional care coverage, managed combines the financing and delivery of healthcare services. This approach has been gaining acceptance over the years. Unlike traditional...
However, in return the patient pays less for care compared to traditional care plans. The managed care network controls and directs all access to the patient's healthcare services (Sekhri, 2000).
The most widely known Managed care organizations include Health Maintenance Organizations (HMOs) and Preferred Provider Organization (PPOs). Under these organizations, the health plan or insurer pays hospitals or doctors directly for a portion or all the costs of the care services the members receive. For instance, doctors might receive a fixed amount per year (capitation) rate regardless of the quantity of care a doctor gives. The aim of the health plan is to eliminate fiscal incentives to prescribe excessive care. Managed care plans also tend to impose laws that seek to manage the care given to members. For instance, they might require members to acquire authorization prior to elective hospitalization or require referrals from primary care doctors prior to seeing specialists (Kongstvedt, 2012).
Under managed care organizations, the primary care doctor is at the heart of the healthcare delivery structure. Under these plans, one of the most importance decisions is choosing a primary care, doctor. The responsibilities of the primary care doctor include taking total care of members and may act as a watchdog to traditional care services. This implies that the primary care doctor is accountable for referring patients to other physicians or specialists.…
