Cost control is very common in the medical field. There are many methods used to keep medical costs low. One such method is managed care. Managed care is a system of healthcare in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.
critical aspect of cost control is types of payers,
which will be the focus of our presentation today. There are 4 types of payers in the United States.
TYPES OF PAYERS
Health Maintenance Organizations
Preffered Provider Organizations
Point Of Service
Exclusive Provider Organizations
employ doctors, pharmacists, dentists, laboratories, and hospitals in an integrated and patient-focused network
This insurance plan only covers care from providers within the network and generally has low deductibles or co payments, or none at all beyond the monthly premium.
providers are paid according to the number of patients enrolled in the plan.
Bonuses may be paid to physicians for keeping costs down.
More flexible then HMO'S
Insurers contract with private physicians and hospitals to provide treatment and care at a reduced cost in return for an increased number of patients.
PPOs have set co payments for insured individuals when they receive services, usually with an annual deductible.
The insurance company typically charges lower monthly premiums for a PPO than for an HMO.
it is possible to see specialists outside of the network of providers, but the deductibles and copays are higher.
Have smaller deductibles and copays than a PPO
Require you to get a referral from your primary care provider before seeing a specialist.
Plans charge an access fee for a network of healthcare providers at reduced rates
Premiums usually lower than an HMO plan
Providers paid on a fee for service to reduce overuse of service