They are less expensive for employers and for employees. Coverage is paid for in advance, monthly or quarterly. The premium does not vary depending on use of services. Because the financial success of the system is based on limiting use of services, there is a built-in incentive to limit patient care. The primary physician becomes a gatekeeper, referring patients to specialists or other treatments.
Gatekeepers can create difficulties for people with a life-challenging condition in several ways.
Generally they are not specialists and probably have the financial incentive not to refer patients to specialists. Because they are usually general practitioners, they may lack the experience to detect symptoms or subtle changes that could raise a red flag to a specialist. Some plans provide that the specialist may also be the primary care physician. For the insured, there are no bills and no maximums. Most managed care plans do not impose any waiting periods for pre-existing conditions and generally cover preventive care.