Health Care Delivery: Deciphering the Managed Care System

The concept of traditional health care has now been replaced by the concept of Managed Care Organizations (MCOs). In a more traditional from of health care delivery patients had the freedom to see the physician of their choice. Physicians were able to order whatever services they felt were necessary. Health plans were mostly set up as passive parties who paid for all services that a physician ordered at the provider's usual charge (http://www/mcareol.com/factshts/factover.htm, 2003, para 2).

The delivery of health care is now a lot more complex in the managed care system. Managed care is a system that involves the coordination and arrangement for health services and coverage of health benefits. Some of the most common types of Managed Care Organizations include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Exclusive Provider Organizations (EPOs). Managed care generally consists of three main components: oversight of medical care provided; contractual relationships and organization of the providers giving the care, and the covered benefits associated with managed care rules (http://www.mcareol.com/factshts/factover.htm, 2003, para 1).

In the last decade managed care has become the most used form of health insurance in the United States. There are over 51 million people who are enrolled in health maintenance organizations, better known as HMOs. This is the most organized form of managed care (http://www.consumers.org/q&anet.htm, para 2).