MCO COVERAGE 2
Managed care organizations or the MCOs as they are popularly known,seek to reduce the cost of healthcare in the U.S. while at the sametime enhancing the quality of care. Managed care employs a number oftechniques to achieve these goals. In this form of care, cliniciansare required to consider the cost of care they provide. This iscontrary to custom where clinicians would provide care regardless ofthe cost. According to the proponents of managed care, there arenumerous unnecessary health care services that should be eliminated.This should significantly reduce the cost of health care. They haveargued that this would not affect the quality of care since theservices that are removed are indeed unnecessary.
MCOs use techniques that are considered counter-productive to managehealth costs. For instance, patients who lack a specialized doctorfor a serious ailment within their network may decide to look outsidenetwork for a doctor. Unfortunately, the MCOs limit this henceaffecting the quality of care for some patients. Furthermore, thenetwork of providers is severely affected by the MCOs. They ensurethat the networks comprise varied specialists who can provide carefor patients. Moreover, the networks are kept small for managementpurposes and to ensure they have enough patient bases. Since theMCO’s collude with insurers, some essential benefits have beenremoved. For example, there are some insurers under the managed carewho do not provide mental health benefits to children.
Despite the shortcomings associated with MCOs, research hasindicated that they offer sound financial plans. Many healthcareproviders who were operating under the fee-for service umbrellacollected billions of dollars for unnecessary services that theyprovided to patients. MCOs have managed to eliminate theseunnecessary services and in the process reduce the costsignificantly.