University of Guyana

Faculty of Health sciences

Department of Public Health

HSC 3201 :Legal and Ethical Issues and

Psychology
Managed care
1. Define the term managed care.
2. Outline the features of access to managed care
3. Describe the physician patient’s relationship in managed care
4. List four (4) reasons why physicians reject patients
Thank you for your suggestion!
Managed care

 A system of health care delivery that tries to manage the cost of health
care, the quality of health care and access to health care.

 It comprises a panel of contracted providers that is less than the entire

universe of available providers
Definition continued

 Some type of limitation on benefits to subscribers who use non-contracted

providers (unless authorized)
&
 Some type of authorization system.
Mclaughlin (1998)
Definition of Managed Care Setting

A managed care setting is one where health

care is monitored and administered in a manner
that reduces cost.
This type of system relies mainly on a
primary care giver who acts as a
gatekeeper for specialist treatment,
surgeries and physical therapy.
Cont.

 A rational management rather than an individual provider is assumed to be

in charged of trading off between cost, quality and access
 This forms the set of common interest between managed care and public
health.
Physician – patient relationship in a managed
care setting

 The physician-patient relationship has been and remains a keystone of care,

it is the medium in which data is gathered, diagnoses and plans are made,
compliance is accomplished, and healing, patient activation, and support
are provided. 
 In a managed care setting a number of challenges are presented to physician
patient relationship, such as shorter visits, decreased continuity and lower
levels of trust.
Physician – patient relationship in a managed
care setting

 The foundation of the patient-physician

 relationship
 is the trust that physicians are dedicated first and
foremost to serving the needs of their patients.
 Suggestive offerings
criteria

Managed care Public health Legislators

Cost Access Cost

Quality Quality Access

Access Cost Quality

Access

 One of the first issue which arises.

 Some populations experience limited access.
 The vendor (provider)has a right to reject business.
Reasons why physicians
reject clients from some providers

 Low payment scales

 Bureaucratic red tape and slow payment
 Adequate demand from other populations yielding more income
 Non –acceptance of patients by other patient groups (may be associated
with racial and ethnic discrimination)
Conclusion

 Manage care is a model in which service providers can be incorporated into

the main stream care, through availing their services on a contractual basis.
 Salient features of services provided in the managed care settings include
the quality, cost and access.