Overview of U.S. Managed Care
Federal Regulation of Health Maintenance Organizations
Managed care generally refers to a payment system or delivery arrangement in which a health plan attempts to control or coordinate the use of health services by its enrollees in order to control spending and promote health. Like fee-for-service insurers, managed care organizations (MCOs) accept financial responsibility for a set of benefits in return for a premium paid by or on behalf of each enrollee. Unlike fee-for-service insurers, MCOs directly provide or arrange for health care services, through affiliated physicians, hospitals, and other providers, instead of simply paying bills. MCOs try to control hospital admissions, diagnostic tests, or specialty referrals,…
