Managed Care

Managed care is an organized system of healthcare delivery designed to control costs through the coordination or management of services. Cost containment is sought through a combination of methods including benefit design; select clinician/provider networks; utilization management; promotion of best clinical practices; emphasis on health promotion, disease prevention, and chronic disease management; administrative functions optimization; bulk purchase discounts for services and medications; and stimulation of competition. Managed care systems typically deploy a “gatekeeper” as an intermediary between the person seeking care and the care provider. The gatekeeper may be a primary care physician or other clinician, healthcare organization, or an insurance company (Bobbitt 2006; Cummings 2006). Health maintenance organizations (HMOs), the best known and oldest form of managed care dating back to the 1920s, are the prototypical gatekeeper model and cover healthcare costs for a given period...