Managed Healthcare

Managed Healthcare

A health delivery and financing system where an enrolled population pays a fixed annual fee (capitation) to a medical provider for access to health services as needed.

Financing Health Care The Managed Care Model

There are many models for finance and delivery of medical services, among which are self- financing (out of pocket as need arises) and various forms of risk pooling. The high cost of medical care, particularly in case of hospitalisation, makes self financing out of reach for all but the wealthiest members of society.
Thus risk pooling - where a large number of people contribute a small amount each year, or the benefit of the relatively few who actually become ill - has gained a significantly greater role.

The Challenge of Affordable, Accessible Care

In a developing country, with limited resources, the challenge is to ensure that resources available are put to their most efficient use, and it is therefore important to encourage providers to offer creative alternatives to government health care provision.
Avenue Healthcare offers affordable high quality medical services in the market based on the principals of Provider-based Managed Healthcare. This form of risk pooling eliminates the need for costly middle men, such as insurance companies, by making the medical provider itself a repository for the pooled funds.
The provider, instead of investing in office buildings, the stock market, or interest bearing bonds, uses member funds to build hospitals, clinics, and otherwise invest in medical equipment and facilities to be used for patients as need arises. This direct link from patient to provider offers the most efficient solution in reducing costs while providing a regular and predictable source of income for the provider.

Financial Risks of Medical Care

• Risks associated with the costs of medical care are borne by the patient.
• Insurance Risks associated with the costs of medical care are borne by a third party.
• Capitation Risks associated with the costs of care are transferred to the provider.