Managed Care Organizations Case Study Example | Topics and Well Written Essays - 750 words

Managed Care Organizations - Case Study Example This issue has been criticized with the claim that the practice will lower the quality of care. The rigidity of rules regarding the choice of health care providers has been criticized, which is specially a reality for Health Maintenance Organizations. Sometimes, a member may be dissatisfied with the care provided by a primary care practitioner and would wish to consult with another one who is not involved in the network accessible via their managed care giver. The only option would be to do so and pay for the costs in full out-of-the pocket. A number of members complain and suggest that in order to save some cash, their managed care providers contract less-educated and inexperienced health professionals. Some criticize the service arguing that their primary care givers make them experience unnecessary tests and treatments for their conditions for them to make extra money (Robinson & Ginsburg, 2009). The third criticism against managed care is its strictness to SOPs that must be adhered to. For example, the necessity to get approval from the insurance provider prior to starting any treatments as well as the length and type of treatments. Most people also complain on the long waiting periods for them to be appointed, the inconvenient locations for clinics and network givers’ offices, or that the allocated time for appointment does not match their busy schedules. In this plan, the basic structure entails members receiving a yearly allocation of Health Reimbursement Account (HRA) finances from their employers, which they may use to purchase covered services. The allocations often range between a thousand dollars and two thousand dollars annually. Unused finances can be carried forward into years ahead and added to the following annual HRA deposit. In the CDHP, when the HRA fund is exhausted, the specified member must adhere to a deductible gap