Essay about Major Criticisms Of Managed Care

1102 Words Nov 6th, 2015 null Page
There are three major criticisms of managed care. The first one is the reluctance by managed care plans to pay for physical therapy and other treatments that do not cure a chronic illness but that allow patients to lead more normal and productive lives. They usually refuse to pay for prolonged physical therapy and for medical devices. The second complaint is the practice of using a general practitioner as a "gatekeeper" who must approve all procedures and referrals to specialists. The third criticism is the failure of some Healthcare Managed Organizations to set aside expenditures for wheelchairs, walkers and other medical equipment for patients with chronic conditions. However, they can provide these same items for patients who are merely recovering from an injury (Bertko, 2004). A CHDP is based on a high deductible and a financial account with a special tax status, where the account contribution limit is less than the deductible amount. The enrollee uses the account to pay for services until all funds in the account are spent. The enrollee then pays out of pocket for all expenses until the deductible is reached, at which point costs are covered by the plan. This type health plan aims to make health care costs more transparent to the enrollee so that there will be more active participation in managing healthcare needs. The evidence from employers and health plan point to a reduced total spending and several plans affirm that CDHP enrollees ' out-of-pocket spending grew…

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