Chapter 27 - managed care

Question 1

Aims of managed care

Answer 1

• reducing the cost of medical events
• improving the quality of care provided
• ensuring that medical services are provided in appropriate settings
• ensure that high risk patients are managed and receive appropriate care
• reducing the number of unnecessary medical services

Question 2

Treatment protocols

Answer 2

• govern the the treatments and medicines that members have access to for certain conditions
• must be updated regularly

Question 3

Abused of managed care protocols

Answer 3

• possible for some insurers to use managed care as a means to unfairly exclude relatively unhealthy lives