is appropriate to the least cost to the managed care organization, as contrasted to being appropriate to the needs of the patient. These outcomes are sought through the use of primary care gatekeepers, limitations on specialty referral, and the monitoring of physician practice, each of which is inimical to the quality of care delivered to the patient.
Coverage policies of managed care organizations limit services that will be reimbursed. Traditional insurance mechanisms are strategies that discourage enrollment of high-risk patients, excluding coverage for preexisting conditions, and experience rating (Quickel, 1996). Managed care takes the traditional insurance mechanisms a step further by limiting the services that will be paid for enrollees, thereby lowering the quality of care available to enrollees.
Over the past 50 years, managed care programs have existed such as the Kaiser Permanente Medical Care Program (California) and the Health Insurance Plan of New York City. These prog
...