Gatekeeper System (BHS450)
BHS450 discussion Module 3: Gatekeeper System Week 1 of Module 3 A Managed Care Organization (MCO) is a generic term used to refer to a managed care plan. The main purpose of an MCO is to provide the infrastructure for the delivery and administration of care within a managed care system. In other words, the MCO is an organization that arranges to deliver health care services without having to use insurance companies or third party administrators. One of the main goals is to provide quality care at reasonable prices. One tool used to do this is through a gatekeeper system. Gatekeeper is an informal, but widely used term that refers to a primary care physician (PCP) responsible for referrals or authorizations for non-emergency specialty care. The Gatekeeper is the provider of first contact. Gatekeeping refers to a method of coordinating and/or controlling utilization. This is a predominate feature of almost all HMOs. For this discussion question, take a position on whether or not you agree with the notion that a person is forced to see a PCP before being referred to a specialist. Does this practice impede quality care? Can the delay in seeing a specialist cause greater harm to a patient? In preparing your response, ensure that you properly in-text cite all sources used in the support of your stated positions and the example or examples you chose to utilize. The response needs to be a minimum of 250 words. Also, you will need to include the references at the end of your posting.
Health care gatekeepers
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Health Care Gatekeepers
Introduction
Most insurance companies have networks of hospitals and doctors have necessitated the need for gatekeepers in the provision of financial services. Most families also rely on family doctors who provide referrals to specialists in cases of more complex scenarios that he cannot handle.
There is need to visit a primary care physician before being referred to a specialist
I agree with the notion that an individual should visit a (Primary Care Physician) PCP first before proceeding to see a specialist. The physicians also have deeper knowledge in medicine in all areas. This means they can be able to detect preventable sicknesses and diseases in early stages thus reducing unnecessary doctor visits which only cost the patient more in terms of money and time (Global Health Policy, 2010). In case there is need to visit a specialist, the physicians are able to refer the patient to the best specialists since they have the knowledge of what the patient is suffering from and know the best doctors to handle it. The gatekeepers provide medical history of the patient to the specialists allowing quicker diagnosis of the disease or illness that the patient is suffering from, he will als...