Introduction to Managed Care - 275 Words

Introduction to Managed Care (Essay Sample) Content: Introduction to Managed Care Name Institutional Affiliation Introduction to Managed Care Health Maintenance Organization (HMO) is a managed care plan that requires the insured to obtain their health care from a specified network provider to which they are restricted. Those who join the network are assigned a Primary Care Physician (PCP) that ensures the assigned member receives health care services. The advantage of HMO is less out-of-pocket expenditure by members owing to less copayment fees paid for doctor visits. The disadvantage, however, is that members are restricted to the network and they must obtain a referral in order to obtain services from outside the network. On the other hand, Preferred Provider Organization (PPO), provides both in-network and out-of-network health care coverage. Members incur lower costs when they stay within the network although they are not restricted to that network as in the HMO. However, when a member opts to seek for health care from outside the network the expenses are high. The advantage of PPOs is that they offer a wide network for members to select from as well as a large pool of doctors. The major disadvantage is h...