Question

Lesson 2: Managed Care Delivery Systems

Upon completion of the Required Readings, write a thorough, well-planned narrative answer to the following discussion question. Rely on your Required Readings and the Lecture and Research Update for specific information to answer the discussion question, but turn to your original thoughts when asked to apply, evaluate, analyze, or synthesize the information.  Your Discussion Question response should be both grammatically and mechanically correct, and formatted in the same fashion as the question itself. If there is a Part A, your response should identify a Part A, etc.  In addition, you must appropriately cite all resources used in your responses and document in a bibliography using APA style.

Discussion Question 2 (20 points)

Discussion Question #2 is comprised of two parts. Base your response to the following by considering this fact: Physicians are the primary controller of costs in the health care system. (20 points) (A 1-page response is required).

Part A	Discuss why. (10 points)
Part B	Address how managed care plans can affect the above stated fact. (10 points)

Answer 1

Answer :

Lesson 2.

Managed care delivery systems : it is one of the health care delivery system ,it is an in organized manner to manage cost, utilization of services, and manage quality of services.

By maintaining contract with the HMO 'S ( health maintainance organizations) and preferred provider organizations they will provide quality of health care services.

These contract leads to they managed care organizations Will get set of amount which is depending on individual plans.

So that the individual clients may get reduced cost benefits, during in health care services.

Types of managed care delivery systems are :

1. HMO or health maintainance organizations : it will pay for care with in the organization.

2. Preferred provider organizations :

It will pay more in the organizations.

3. Point of services : here the health need clients can select care between the HMOS and PPO.

These medical care delivery systems are certified by the director of department of consumer and business services.

The main goal of managed health care delivery systems are

* controlling or redusing the health care service costs and

* provide quality and comprehension health care services.

Discussion questions 2.

Physicians are the primary controller of cost in the health care system :

Part A. Answer :

Why means

* the doctors only can provide health care services to the clients.

* primarily the clients has to get registered for that fee will be there.

* consultation fee for the doctors will be there, that is for physicians only.

* they will advise to clients different types of tests like scanning, lab tests, and other consultations, etc.

* these and all in physicians hands only.

* the physicians has to know first exact cause of the problem and needed procedures for that problem,.

* that only the doctors or physicians can advise to clients.

* unnecessary things they will not advice.

* by reducing these unnecessary tests and unnecessary bills the health care cost will reduces for the clients.

* put reasonable cost for the resources which are used to provide health care services.

* so it is in the physicians hands only.

* so by the reasonable rates and bills they can reduces the cost in health care system.

Part B) Answer :

Managed care plans can affect the the above the statement is due to :

* the medicaid and Medicare health care delivery system are useful provide low cost for health care services through insurance policies.

* instead of providing fee for services, (FFS) the medicaid and Medicare are available.

* for these systems the physicians can put or apply bill according to the clients care, and they will get money for them.

* forexample they will put 100 /- bill means they can get 75/- from that insurance facilities.

* so that the cost can reduced by the health care seeking clients .

* by the reduced cost by the physicians to the managed health care plans, they may get benefit and these may are helpful to some other persons.

* managed care plans have some limits to provide money.

* if the physician can cross it it may loss to the state government.

* so by avoiding doing unnecessary tests and procedures they can reduces cost.

* the will get adequate billings by insurance.

* if costs are cross the limits the physicians also may not get adequate money for their services.