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The emergence of managed health care In this paper I want to investigate the emergence of managed health care and its influence on health care pros and cons. First of all I want to define what is the managed health care is. I think that it easier to discuss subject when we know what exactly we are going to discuss. Concepts of managed health care are used widely around the world, not only in US, in many places it can be seen as useful approaches to improving the efficiency and effectiveness of health care. It is impossible to give precise definition to managed health care. If make this very broadly we can say that managed health care is attempt to influence the cost, mode of delivery or quality of health care.
The benefit of managed health care still is rather controversial. More that once it was blamed for limiting professional medical autonomy in order to reduce costs and reducing the quality of health care and for restricting patient choice. Of course there are those who supports managed health care and those who are against it. I want to outline that some of the above-mentioned claims are true but managed health care also brought many innovations and improvements in health care field.
According to the David Marcus, Consultant of Social Policy Group Some of these innovations include organizing care around disease groups ('disease management'), better use of clinical and cost information for managing care, and standardizing care to reduce the variability in cost, quality and access to services. US-style managed care in fact comes in many varieties. Moreover, the managed care industry is rapidly changing in response to intense competition, greater government regulation and consumer concerns at over-zealous gate keeping by some companies. Managed care is not a monolithic approach, but in fact consists of a range of relatively distinct tools that can be applied in various ways, without the heavy-handed emphasis on cost control used in the US. (Prospects for Managed Health Care Australia) I am agreeing that managed health care reflects the for-profit motives of managed care organizations. The main source of funds for managed health care is private employers. And that is understandable when employers want their workers to be health.
For example by the late 1980 s General Motors was spending around US$ 1200 per car on health benefits to its employees, at a total cost of $ 4. 8 billion. The US Government is, however, now contracting with managed care organizations for the provision of its major public health programs so it too can take advantage of reduced costs. The cost-control focus of US managed care has made an impact-the annual rate of growth in health plan costs to employers declined from 10. 9 per cent in 1992 to 4. 8 per cent in 1994, and plan costs actually fell in 1996. (Prospects for Managed Health Care Australia) Managed health care is tightly connected to the economy because it obeys market laws as any other business corporation. Norman E. Vinn states Managed care arose to meet market demands, but its growth has stalled. Last decade was successful period for health care.
American economy was very stable and became more competitive in a global economy. According to The Emergence of Consumer-Driven Health Care The gatekeeper model enhanced the role of primary care. The gap narrowed between primary and subspecialty reimbursement. The fragmented physician community began to consolidate. New technologies, drugs and strategies improved morbidity and mortality for many conditions, while decreasing reliance on acute-care environments.
But all that blessings didnt came without consequences. As the result failed many integrated networks and leaved many physicians unemployed. Prepaid system of health care also create huge gap between physicians and patients. Norman E. Vinn writes, Capitated payment systems offered minimal rewards for individualized, compassionate patient care. For many physicians, medical practice lost much of its meaning.
Many of us blamed managed care itself for these events. We didn't recognize that managed care was just a business model that arose to meet market demands. We didn't recognize that managed care was neither the disease nor the cure; it was merely the symptom of an unbalanced health care system. (The Emergence of Consumer-Driven Health Care) So the question is: Do we really face the quality crisis in managed care? Lets face the truth health insurance and managed health care have become synonymous. The question: Is such change for the better or not.
Brett N. Steenbarger, Ph. D. , is Assistant Professor of Psychiatry and Behavioral Sciences and Director of Student Counseling at the SUNY Health Science Center at Syracuse is convinced that health care become worse with the emerging of managed health care. He states Studies of consumer satisfaction published in Consumer Reports, Newsweek, and U. S.
News all suggest that HMO plans vary significantly in their perceived quality. The Consumer Reports study was particularly interesting: 9 of 10 top rated plans were not-for-profit, while all 10 bottom-rated plans were for-profit. The clear implication is that the pursuit of profit in a captivated system may place the interests of health plans and patients at odds. (The Quality Crisis in Managed Care) He outlined that it is necessary to reshape the relationship between managed care firms and mental health practitioners. Why? Because even if managed care organization reduce cost they are not able to produce quality. Lets make some basic conclusions about impact of managed health care on the health care system pros and cons.
Vernellia A R. Randall states MCOs will ultimately change the perceptions and expectations of society, physicians, patients, and third-party payers regarding what is owed to whom, what treatments are appropriate in what circumstances, and even what qualifies as a disease. Quality assurance, utilization review, and practice parameters are essentially designed around data based on middle-class populations who have generally had adequate access to health care. In other words managed health care forced ought all thoughts about health care as care of health. That was negative point of view on managed health care because for middle-class populations managed health care system works perfectly. But Department of Research and Collective Bargaining Services states There are questions the union can ask about a managed care plan, whether it be a HMO, PPO or hybrid-type plan, to determine the quality of care available, whether care will be accessible when it is needed, and whether patients will be fully informed and able to challenge decisions made about their care.
Quality of care can be measured by the quality of doctors and facilities in the network, staffing levels and staffing mix, preventive services and outcome measures, patient satisfaction and care management standards For nowadays exist three kinds of managed health care (Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Point of Service (POS) plans). They cover all possible opportunities of health care. Patient is able to choose what managed care plan attract him more and be sure that medical insurance will be on top level. Managed care plans are generally very willing to provide preventive care and to treat routine illnesses, but may be less willing to provide more expensive care. Patients who are unhappy with a plan are frequently those who have suffered a serious illness or injury and feel that they have been treated inadequately or denied medically necessary care.
Surveys should include questions about serious illness or injury. Finally, a good plan should educate enrollees about how to use the network in a way that minimizes confusion. For example, plan members should be able to call one telephone number and access all areas of the plan's administrative services. (Managed Health Care: Your Knowledge or Your Life) And what about utilization review and prior approval as effective management tools in controlling health care cost and assuring quality of care? They are effective because in such was patient can control all the health care process.
And can control expanses too. According to the Health Insurance and Managed Care Appeals and Grievances for Patients Under the New York Managed Care Reform Act Most health insurance plans, whether they are provided by HMOs or traditional insurers, exclude coverage for services which are medically unnecessary. The process by which a health plan determines whether or not a service is "medically necessary" for a patient is known an "utilization review" It can occur before or after patients receive medical treatment. Utilization review is rather useful in the cases of expansive treatment (surgery, transplantation, etc) In such cases it is better to ask for prior improvement. Or in other words make sure that suggested medical insurance is really necessary.
The methods used to compensate managed care providers may encourage them to provide less, rather than more, care to plan participants. Public disclosure of financial arrangements with doctors, as well as information on utilization review standards and decisions, grievance or appeals procedures, and limitations of coverage, are extremely important. Consumer oversight boards, including health care workers and union representatives, can be a vital part of protecting patients' rights. Currently, about 60 percent of managed care plans pay physicians on a capitation basis. Some pay a bonus to those who keep costs below a certain level, or apply penalties to those who exceed specified costs. Many plans restrict physicians from disclosing incentives to limit patient care.
Try to find out how physicians are paid (Managed Health Care: Your Knowledge or Your Life) Bibliography Mark Smith, Managed care receives blame for overmedication's, Houston Chronicle, 1997 web Josh Roberts, Contributing Writer, Economic impact of managed health care concerns doctors. web Diane Breast, R. Ph. , M. B. A, Health Care Communications Agencies Respond to Managed Care, 1998. web David Marcus, Consultant, Social Policy Group, Prospects for Managed Health Care in Australia, June 20, 2000.
web Managed Health Care: Your Knowledge or Your Life, AFSCME Department of Research and Collective Bargaining Services. web Lucy Canter Kihlstrom, PhD, Managed Behavioral Health care firms and Institutional Theory: Is the Case Convincing? , Institute for the Study of Healthcare Organizations & Transactions, 2000. web Norman E. Vinn, DO, The Emergence of Consumer-Driven Health Care, American Academy of Family Physicians, 2000. web Brett N. Steenbarger, Ph.
D, The Quality Crisis in Managed Care, Department of Psychiatry SUNY Health Science Center Editor, psyc OH! , web Vernellia A R. Randall, RN, MSN, JD, IMPACT OF MANAGED CARE ORGANIZATIONSON ETHNIC AMERICANS AND UNDERSERVED POPULA TIONS, web Health Insurance and Managed Care Appeals and Grievances for Patients Under the New York Managed Care Reform Act. web
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Research essay sample on The Emergence Of Managed Health Care
