Essentials of Health Policy and Law 2nd Edition by Joel Teitelbaum,Sara Wilensky

Exercise 7

Cost containment strategies embraced by MCOs were a direct result of the FFS experience with ever-increasing utilization and healthcare costs. However, many consumers and providers chafe at the restrictions imposed by MCOs and are concerned that someone other than the provider is making treatment decisions. Are these restrictions appropriate and necessary? Do you favor some of the restrictions over others? Is it appropriate for one entity to be responsible for both paying for and providing care? Should someone other than an MCO-say the federal or state governments-have primary responsibility for making determinations about service utilization?