Managed care is the most common form of health care in the United States and mammoth Cigna NIB conglomerate Honeysuckle, is insidiously introducing this US Style Managed Care into the Australian Healthcare System.
It is available to individuals in three common formats:
- PPO = Preferred Provider Organizations
- HMO = Health Maintenance Organizations
- POS = Point-of-Sale Care
Without health insurance, the costs managed care can be extremely high. In the United States, CNBC reports there are nearly 650,000 bankruptcies declared every year because of medical bills that are owed.
US Style Managed Care
- Limits Care access for those who do not have or cannot afford private health insurance
- Rules of managed care are very rigid – options are limited in terms of choosing your own Doctor – your insurance will have their own “in-Network” Doctor within the PPO & HMO. Should you want to seek second opinion, you will be forced to go “out” of the preferred network at your own cost.
- People are forced to advocate for themselves and for their treatment. In particular for “advanced complex treatments” which often involves Specialists “outside” the network. Approval from Insurance must be attained to be covered i.e., must be pre-authorised by Insurance first to ensure coverage of fees. This is called “Pre-Authorisation”
- Patients care essentially comes down to dollars and cents – In Network Doctors are known to perform unnecessary tests in order to maximise money paid to them by insurance companies and or refuse to order necessary tests as it requires referral outside the “network” i.e., PPO’s & HMO’s and hence extra fees that may or may not be “covered”.
- Loss of Privacy – data is reviewed by managed care organisations is not guaranteed to be secure from data breaches
- “Local Networks” intended to make healthcare accessible and affordable are often inundated, leading to long wait times.
Protect and Preserve Australian Healthcare. Write to your Local MP and together we can send the eagle home!