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Comparison and Contrast of Managed Care Organizations, Medicare and Medicaid

Managed Care Organizations

The Managed Care Organizations cover economic incentives for the patients and doctors. The Medicare renders substantial security from medical expense risk, and security that has enhanced in current time. The Medicare creates Medical-related financial burden, such as issue in paying collection agency contact and bill. The Medicaid is helpful to serve fundamentally the lower-income individuals and not only the elderly but the individuals of all ages. This essay compares and contrasts managed care organizations, Medicare and Medicaid.

While making comparison between the Medicare, Medicaid and Managed Care Organizations, it is found that these all are government sponsored healthcare programs in USA (Butler, 2019). They all cover the services such as emergency service, family planning, routine care and client satisfaction services. It is also recognized that they cover the people of every territory, state and Native American reservation.  Following table contrasts Medicare, Medicaid and Managed Care Organizations -

Managed care organizations




Managed care organizations are run by Health Maintenance Organizations and Preferred Provider Organizations. They are applicable in case of both patients and doctors. They help to choose less expensive methods of healthcare. It is noted that there is coverage on the monetary incentives for the client and doctor to increase beneficiary cost sharing and regulate inpatient admission and stay duration. The cost of managed care organizations is between 25% and 33% and sometimes higher at some biggest organizations (Haas, et. al, 2019).

Medicare is a central program with identical national regulations. The eligibility of Medicare begins as earlier as age 62 or earlier in case of serious disabilities. The Medicare include clinic facility, post-hospital facility cost, cost of lab, outpatient care and prescription drug coverage. It is annual deductible for 3 Medicare plans (Agarwal, et. al, 2020).  

Administered by states and information is available at the state's health services office. The low income people (regardless of age) are eligible for Medicaid. It covers fundamental health care cost like visit cost and stay cost. However, it also covers things such as spectacles and sometimes small cost. It also includes 20% of medical cost that will not be paid by Medicare.

The gate keeping means healthcare provider regulating treatment of patients, making decision, referring patients to another professional after the approval. It can be made used by making the healthcare access to all, with less cost and minimum quality outcome and satisfaction of patients. It is achievable only while accurate care is provided to the patient timely because it renders option for more proper and effective services. The patients who look for the existing and improved sophisticated treatment and care provided properly (Sripa, et. al, 2019). The system always renders chances to the patient to make own decision in case of under managed healthcare. Even though, the gate keeping addresses financial elements into decision of treatment decision. It is useful system to the people as well as state. The gate keeping system if administrated properly can enhance the health care quality and standard. The well-managed gate keeping system also ensures timely delivery and facilities in the nation. In addition, some resources at hand gate keeping help to meet the requirements and fulfill demand of people. In this way, the gate keeping has achieved wide range of assistance and public acceptance (Zheng, et. al, 2018).

Moreover, the alternatives to facilitate drain on Medicare resources will be effort of upstream process such as prevention at young age. When the people get access to healthcare services from starting, the economic burden because of health issue will be reduced. In this way, with less taxation slab, it will be easy to better deliver healthcare services to the people with universal health coverage.   Furthermore, the alternatives to facilitate drain on Medicaid resources involve use of private health insurances, cost sharing by beneficiaries, motivation to select cost effective care and health saving like accounts. The clients should be skilled to make best use of the Medicaid services by choosing cost effective care (Cherla, et. al, 2017). 

As per the above analysis it can be concluded that the central share of Medicaid saving will more than offset subsidy for premium enhance for lower-income beneficiaries with the new advantage setting. The government should restrict doctors to take additional charges for the fundamental medical care. It is required to encourage preventive measures such as proper lifestyle, physical exercise and proper diet to reduce chance of becoming ill.


Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review: A systematic review of the impact on spending, utilization, and quality outcomes from three Centers for Medicare and Medicaid Services bundled payment programs. Health Affairs, 39(1), 50-57

Butler, S. M. (2019). How an expanded vision of managed care organizations could tackle inequities. Jama, 321(21), 2063-2064

Cherla, D. V., Olavarria, O. A., Holihan, J. L., Viso, C. P., Hannon, C., Kao, L. S.  & Liang, M. K. (2017). Discordance of conflict of interest self-disclosure and the Centers of Medicare and Medicaid Services. journal of surgical research, 218, 18-22

Haas, D.A., Zhang, X., Kaplan, R.S. and Song, Z. (2019) Evaluation of economic and clinical outcomes under Centers for Medicare & Medicaid Services mandatory bundled payments for joint replacements. JAMA internal medicine, 179(7), 924-931

Sripa, P., Hayhoe, B., Garg, P., Majeed, A., & Greenfield, G. (2019). Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review. British Journal of General Practice, 69(682), e294-e303.

Zheng, N. T., Li, Q., Hanson, L. C., Wessell, K. L., Chong, N., Sherif, N. & Rokoske, F. (2018). Nationwide quality of hospice care: findings from the Centers for Medicare & Medicaid Services hospice quality reporting program. Journal of pain and symptom management, 55(2), 427-432

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