EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY Essay - 3

EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY - Essay Example Managed care organizations, commonly referred as MCOs (Pozgar 2012) have been a key feature in this sector. According to the (Altenstettter &Bjorkman 2000) it has been seen that integration of both the insurer and provider functions been in the increase. Health Maintenance Organizations not only finances, but also ensure delivery of health services, which are comprehensive, to all the bonafide beneficiaries. The charges, under this model, are made on the employer for each subscriber. The fixed premium charge goes a long in giving the beneficiary rights of both being insured and provided medical care in case of ailments (Pozgar 2012). Subscriber should though note that, once in this system they can only get service from HMO contracted physicians. The HMO model has several forms which include staff and Independent practice association model. Under staff-model, an arrangement is made for the physician to proved services to the subscribers on full-time basis. The IPA- model has arrangeme nts made between the independent physicians and HMO to offer services on contract to the beneficiaries. Health care services can be bought from a group of providers who are carefully selected. Care in selection is emphasized so that the beneficiaries get the best treatment. This is accomplished through preferred provider organizations which are characterized by a well utilization management plan. Under this model, negotiation of payment rates and speeded payment terms are facilitated. In addition, the beneficiaries have freedom to choose services from other providers though at their own cost (Pozgar 2012). The major essence of this model is the negotiation of charges between the payer and panel providers whom the terms are on contract basis. The payer also selects a panel of providers whom are consulted by the enrollees in case of ailments or other medical necessities. This model has