Chapter 27: Managed Care

Question 1

What are the aims/objectives of managed care?

Answer 1

MAQ

Manage claims cost - reduce the cost
Keeping healthcare Affordable
Balance with high Quality healthcare standard

Question 2

What are the benefits of managed care?

Answer 2

Restrictive protocol= cost effective
Clinical trials could influence decisions on protocols
Legislation can force certain protocols
Competitors can affect certain protocols

Question 3

What are some examples on managed care programmes?

Answer 3

1. Restrictive formulary governing which medicine may be used for certain conditions
2. Requirement for GP referral
3. Network (with whom there is an agreement in place in terms of charges)

Question 4

What are some disadvantages of treatment protocols?

Answer 4

1. Procotols can be unfair and exclude unhealthy loves
   Bias and discrimination (Legislation can combat this)
   Reputation (PH may first come to know of protocol when they claim)