Hi Could someone please provide a high level view of how managed care organizations work. From my understanding they are funders of healthcare and negotiate terms with providers to reduce costs as well as ensure quality of healthcare is improved. However in the F101 South African notes, it states that Managed Care organizations are intermediaries between insurers and healthcare providers. In which case I do not understand their role.
Hi Jessi First of all I'd like to reassure any SP1 students that are reading this post that this question only applies to the South African course F101. Managed care organizations are not covered in SP1 (although the concept of managed care gets a brief mention in the Glossary) but have their own chapter in F101. Now to your query Jessi. I agree with your definition, managed care organizations are there to negotiate with healthcare providers to reduce costs and ensure quality. They can be hired by an insurance company or other medical scheme to perform this task on their behalf, so in this sense the managed care organization acts as an intermediary between the insurer and the healthcare provider. An intermediary is any person or company that acts between two others. The notes are not suggesting that the managed care organization is an intermediary in the sense of being a broker that helps policyholders choose an insurer. Best wishes Mark
