Thursday, March 29, 2012

Essay on Health Care Organization

Essay on Health Care Organization

1. Main types of managed care organizations: group practice without walls, independent practice association, management services organization, and physician practice management company.

The major types of managed care programs include: Independent Practice Association (IPA), Preferred Provider Organization (PPO), Point of Service (POS), and Managed Care in indemnity insurance plans.

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2. Advantages of Managed care organizations include: increased efficiency, improved standards, better understanding between cost and quality. Critics of such organizations emphasize on the fact that managed care that seeks for profit cannot be successful health policy, it increase the quantity of uninsured people, move away health care providers, and has substantial pressure on quality.

3. Aetna is the HBO that provides the wide range of health care services, insurances and related products. It is a member of Fortune 100. Aetna was founded in 1850. The company provides dental, health care, group life, pharmacy, employee and long-term care insurance, by means of benefit programs. Among company’s members are a lot of medical, dental, pharmacy members, health-care professionals, primary-care doctors and specialists.

4. Medicaid differs from other managed care organizations by the fact that it is the national program for families as well as individuals with low incomes or lack of resource, it is also funded both by state and federal government. This company is more social protection program then social insurance one.

5. PPO- Preferred Provider Organization, a MCO of hospitals, medical doctors, and other providers of health care who have agreed with an insurer to provide care at lower rates to its clients.
Gate keeper­- is referred to the primary care physician in accordance with their role, frequently used during Congressional Health Committee.
Primary care physician- is the doctor first examines the patient when it is unknown what his health problem is and then continues care depending on what he had diagnosed.

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