Managed Care, Physicians, and Patients

Managed Care, Physicians, and Patients

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Give three examples of common assertions about managed care impact on physicians and physician/ patient interaction. Explain how these assertions are proven true or false by evidence.

Kongstvedt (2007) argues that managed care has impacted the way in which patient and physicians interact .Now, physicians are held more accountable, and patients are more actively involved in their care .The following are three examples of common assertions about managed care impact on physicians and patient interaction. However, these assertions are proven true or false by evidence.
1. Many critics of managed care argue that utilization review personnel decisions in regards to necessary treatment overrule doctors’ decisions frequently and coverage denial rates for physician recommendations are very low. However, Kongstvedt (2007) states that a national survey that was carried out with over 2,000 physicians caring for patients plans utilizing manage care techniques discredit this claim. In fact, the survey revealed that the final coverage denial rate for physician recommendations was at most 3% within eight categories and much less for most categories of care.

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Also, initial denial were reversed by health plan, resulting in lower rate coverage for hospitalization was denied only by 1% of the time, surgical procedure 1.2% and specialized referrals 2.6%.

2. Many critics of managed care argue
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