delivering health care

Managed care is a method of delivering health care in which a single entity manages finance, insurance, delivery, and payment. Health maintenance organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS) are three types of managed care in the market.  The emphasis, intention, and audience of all these categories differ from the others. HMO emphasizes health care offering medical treatment for those in need as well as many other services to assist individuals to maintain their health. In reaction to the expansion of HMO plans, PPO plans are being introduced. To get coverage within an HMO, the individuals must stay within the network of providers whereas in the PPO plan individuals can have access to the network and out of the network of providers. According to Shi (2015), HMO has providers on staff as well as contracted. In the case of PPO, providers are contracted. HMOs need referrals for specialty treatments, but PPOs allow patients to access them without restriction. As mentioned by Managed Care outlook (2013), HMOs create networks of providers (doctors, hospitals, specialists, etc.) from whom members may select to receive treatment. While less flexible, HMOs tend to be less expensive with fewer out-of-pocket costs. PPO programs allow customers greater control over their health insurance coverage and treatment quality. HMO is preferred by most due to low monthly and out-of-pocket costs even though it doesn’t cover all the areas and treatments.

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