What is managed care?
The easiest way to define managed care is to compare it with traditional health care, the kind of health care most of us are used to. Under traditional health care, doctors and hospitals are independent of each other. Doctors and hospitals set their own fees for services. You can go to any doctor you choose and you are responsible for determining if your doctor is qualified to provide the care you need.
Under managed care, doctors, hospitals, as well as other health care providers agree to work together. Health networks are formed. These networks agree to provide health care services to members (you) for a set fee or price. You are encouraged to use providers who are part of the network. If you go out of the network for care you might have to pay more for health care. The network sets criteria for the selection of health care providers and also monitors the amount of care and quality of services provided to members. In other words, the network makes decisions about the qualifications and skills of the providers. The most common form of managed care is an HMO.
Gail Carlson, MPH Ph.D., Continuing Medical Education, School of Medicine, University of Missouri-Columbia
Last update: Wednesday, November 26, 2008