What is managed health care?
A system for providing health care delivery that may include set payment to doctors, financial incentives for consumers to use certain doctors, and coordination of health care services. There are different types of managed care systems. The most common are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Generally, HMO members must sign up with a medical group and see doctors within that group. Some plans may allow members to see doctors “out-of-plan” at increased cost to the member. In most HMOs, the member chooses a “Primary Care Provider” who becomes the doctor primarily responsible for the member’s care. The Primary Care Provider may refer the member to specialists, if necessary. In PPOs, the member will pay less to see doctors in the plan and will pay more to see doctors out of the PPO. In PPOs, and in some HMOs, your ability to get care may be controlled by a “utilization review committee,” a group that decides if health care services are neces
