Explain health maintenance organization plan


Case scenario:

A gatekeeper is a health insurance term used to describe the person in charge of a patient's treatment and anyone who receives health insurance coverage in the form of a managed care plan, specifically a Health Maintenance Organization plan, is assigned a gatekeeper or allowed to choose one. (www.investopedia.com., 2015). Their duty is to maintain a patient’s medical treatment, which mean the gatekeeper system is there to approve the patient’s referral, hospitalization, and lab work. When the patient gets sick or need to be referred to a specialist, the gatekeeper turns and refer the patient to specialists within network. The advantage of the gatekeeper system, it’s inexpensive to patients and helps them have easy access to specialists and care to hospitals that are in the network. This helps to expand communication with doctors, allow for faster diagnoses, and reduce the trouble of deciding on the best path for treatment. Having the gatekeeper system eliminates the patient finding their own specialists and paying out of pocket for that visit along with a co pay. It’s important that primary care doctors use gatekeeper system in these situations to get patients more specialized care. The disadvantage of the gatekeeper system through level of care is lacking of proof that the gatekeeper can hold down cot for patients being referred to specialists. It affects cost and quality of care for the patient. Today gatekeeper system is lacking use and not really supported by some primary care physicians today. The majority of patients using the gatekeeper system can only see specialists in the plan network and they should have the options to be seen by the specialist that they prefer. With the advantages and disadvantage of using the gatekeeper system, there are no choices to choose from because gatekeeper system should not be an option to use when needing a specialist for an illness that requires the best physician that deal with that illness. The choice is up to the patient too choose who they want to take care of them when they have been diagnose with a chronic illness. Today the gatekeeper system is no longer being used in some primary care offices, because all patients does not have an HMO insurance and the majority are using specialists that are in a Preferred Provider Organization that participate with many specialists, and hospitals.
 
Reference

http://www.investopedia.com/gatekeeper.asp

Solution Preview :

Prepared by a verified Expert
Other Management: Explain health maintenance organization plan
Reference No:- TGS01748436

Now Priced at $25 (50% Discount)

Recommended (94%)

Rated (4.6/5)

2015 ©TutorsGlobe All rights reserved. TutorsGlobe Rated 4.8/5 based on 34139 reviews.