Mechanisms in Managed Care

Select one of the following questions for your initial post,  Please copy and paste the question at the beginning of your initial response so everyone knows which question you are answering. Be sure to include a properly formatted citation from your textbook and a peer-reviewed source for your initial post. The post should be at least 300 words.

You must also respond to one of your classmates’ posts . For follow up posts, you want to add something new to what was already posted (find a case study on the topic and summarize the findings, find a research study and share the statistical findings with the class, provide a real world example of the topic to the class, etc). The post should be at least 250 words.

  • What are the incentives to limit the cost of healthcare under managed care systems? Do you think these incentives help or hinder our ability to have an efficient, high-quality healthcare system? Find at least one reliable resource to defend your response.
  • At this time most health insurance is provided via managed care plans. Managed care plans utilize three main payment mechanisms. Describe the three payment mechanisms (capitation, discounted fees, and salaries) and the pros and cons of each.
  • Describe the role of the National Committee for Quality Assurance (NCQA), managed care report cards, and Healthcare Effectiveness Data and Information Set (HEDIS) in ensuring quality of care provided by managed care organizations.
  • List and briefly describe the main characteristics of managed care. How does managed care differ from traditional fee-for-service insurance?
  • What is the managed care backlash? Are patient and provider complaints about managed care valid? Why or why not?