Question

What is one advantage and one disadvantage of Insurance plans restricting enrollees to in network providers for limiting increases in medical expenditures? Comments should explicitly consider consumer sovereignty and economic efficiency.

Answer 1

Advantage :

Information moves rapidly within a network.

The past, a patient would need to take copies of their medical records with them when referred to a specialist. If they did not, then they’d need to give their authorization to have their medical file transferred to the specialist. With the modern structures of managed care, one single authorization allows the network to access your file when seeing a provider. Even if your primary care provider is in one city and your specialist is in another and with a different company, you can still instantly access your data so that a treatment plan can be developed.

Disadvantage:

It limits care access for those who do not have insurance or provider coverage.

If you’re poor and living in a system with managed care, then your options are limited. Many people in this situation are forced to go to an emergency room for care because it cannot be denied there. Finding a provider in private practice is virtually impossible, even with sliding scale fee schedules, when there is an inability to pay for health care services.