Many believe that managed care helped control medical cost inflation in the late 1980s. On the other hand, many believe that these cost-control efforts also caused the health care industry to become more interested in saving money than in providing quality health care. Whatever you believe, the fact is that managed health care has become ubiquitous in the US, with 90 percent of insured Americans enrolled in plans with some form of managed care, according to America's Health Insurance Plans.
So What is Managed Health Care?
Managed health care plans are a type of health insurance. Managed Care Organizations (MCOs) establish contracts with doctors, hospitals, clinics, and other health care providers such as pharmacies, labs, x-ray centers, and medical equipment vendors at a reduced cost. These health care providers and medical facilities are known as the plan’s “network.” Managed care health insurance plans typically cover a wide range of health services – from preventative care to diagnosis and treatment of illnesses.
General health insurance and worker’s compensation have two slightly different objectives.
Health insurance (including managed health care) is "coverage that provides for the payments of benefits as a result of sickness or injury,” according to the Health Insurance Association of America. It provides coverage for medications, visits to the doctor or emergency room, hospital stays and other medical expenses.
Worker’s Compensation Insurance covers employees for work-related injuries, including not only medical expenses, but also lost wages incurred due to a work-related accident or injury. Keep in mind that while Worker’s Compensation only accounts for about three percent of a company’s total health care costs (about $111 billion), more than half of that $111 billion is paid in lost wages. Therefore, in addition to providing health care for employees, another objective of Worker’s Compensation Insurance is to get employee’s back to work.
By using some of the techniques used in managed care, companies can provide quality medical services to injured workers and get employee’s back to work.
Some of these techniques include:
John is an employee for XYZ Manufacturing. His normal job is lifting 50-lb bags onto a truck. One day, while he’s lifting one of those bags, he twists his back, which causes a lower back injury. The physician advises John not to lift anything over 20 pounds. Using managed care techniques, John could go back to work on light duty rather than missing work completely, saving XYZ Manufacturing the cost of lost wages for John.
We have been supplying affordable, high-quality worker's compensation insurance and health insurance for over 25 years. And, as a Trusted Choice independent insurance agent we specialize in offering multiple insurance offerings from competing insurance brands. We'll help you get the right coverage at the the right price. Call today.