The managed indemnity plans offer the least control of any of the managed care arrangements. Managed care arrangements are constantly evolving because of changing economic constraints, technological advances and the social environment. Many managed care plans now use centers of excellence, medical facilities that provide specialized forms of treatment for highcost chronic conditions such as organ transplants, cancer therapies, cardiac surgery. The centers are chosen based on their outcomes and expertise, location and willingness to negotiate discounted rates. A large number of managed care plans also provide hospice benefits for palliative care for terminally ill patients.
Employers find self-insurance desirable because of potential savings that can be achieved.
For instance, administrative costs are reduced because employers insurers typically add risk charges onto the administrative fees to protect themselves against adverse deviation in claims. In addition, significant cash flow savings can be realized by taking advantage of the lag between incurring of services and actual payment for them. This lag can average as much as three month and the employer is able to use the cash for an additional three months. Park district and special recreation association are usually smaller employers and are not able to assume the financial risk that is inherent to self-insurance. They may wish to have the protection of an insurance contract but may find their bargaining power regarding options such as cost, scope of coverage and access are limited because of their size.