Under this arrangement, consumers, insurance companies, and employees have minimal influence over the fee charged, the appropriateness or quality of care delivered. Managed care systems address cost, access and quality demands through health care systems that encompass both the financing and delivery of health care services to subscribers. Cost is customarily addressed through a capitated fee structure and the implementation of practice parameters. Formal programs for ongoing quality assurance and utilization review are essential components of managed care programs. The goal of managed care is to control costs while maintaining quality.
Providers usually receive compensation as a fixed amount per program member.
Since clinical laboratory testing is an integral part of the delivery of health care and the clinical laboratory scientist, prepared at the baccalaureate degree level, has the expertise in analytical, diagnostic and therapeutic testing, this expertise must be included in the development of practice parameters. As patient advocates, the clinical laboratory scientists provide an integral role in achieving greater economies in the delivery of health care. Clinical laboratory scientists have the unique ability to enhance effective utilization of clinical laboratory services by providing feedback to physicians on utilization patterns, test ordering, cost effectiveness and identification of the clinical impact of irrelevant or obsolete tests. Given the financial incentive for managed care organizations to fail to provide necessary services and to encourage disenrollment of costly consumers, regulatory standards are needed in order to protect the public.