Health Careers and Issues -- JT 01

Manage Care versus Traditional Insurance

Managed Care	Traditional Insurance
Network of credentialed health care professionals provide care	Any health care professional provides care
Restricted access to specialty providers	Unlimited access to specialty providers
Coverage for primary and preventive care	Coverage for acute illness or injury only
PCP usually designated to manage and coordinate all patient care	Multiple providers deliver care without knowledge of total patient health
Extensive relationship with providers, giving them practice management tools and incentives to managed care	Relationship limited to reimbursing providers for care rendered
Financial controls of care	Limited financial controls of care
Programs to encourage patients to maintain good health	No health promotion programs
Tracking and analysis of data on costs, utilization, and quality	Collection of claims data only
Some transfer of risk to providers	Assumption of all financial risk
Prospective review of treatment	Retrospective audit of claims