Managed Care Case Study

1. Describe the Managed Care System in the U.S. and how it is financed.
Managed care involves health insurance plans uniting to a managed care organization (MCO) that eventually combines with a health care provider that leads to have service delivered to the patient covered under a managed care plan. So when the patient needs to go to the doctor or hospital, he or she already will already be covered under a health care plan that will take care of the service provided, the cost of service, and more. Managed care has become the most powerful system in the United States and many Americans are covered through contracts that their private or public health insurance signed with a managed care organization. Managed care is financed because the MCO pays the health care providers either a fixed amount per person enrolled in their plan or through a previous discount arrangement that could have been made with the providers. Many times health care providers make a deal with the MCO that if they get more clientele, then they will

Having access to health services is not usually guaranteed for many individuals and to increase the chances of being able to obtain health care services when needed, many people have started to get insurance coverage. In most cases, people with insurance will have a better access to health services than those who don’t because uninsured individuals are unable to see a physician unless they can afford to pay out of pocket. Typically, those individuals who cannot afford to see a physician when needed wait until the last minute to go to the hospital and at that time it might be too late. Even though having insurance does not really guarantee access to every physician, it does increase the chance of having access to health care services when it is needed. (Shi & Singh, 2015, p.