1. Introduction
One of the hottest issues nowadays in the United States is the rising continuously rising trend of health care expenditures. There are heavy debates about the role of government and insurance companies and the possible solutions. However, little can be heard about the experiences and outcomes of the previous attempts that aimed to restrict health spending.
However, during the long tradition of rising health care costs there was a temporary break in the 1990’s. The period of this break actually corresponded with the time of ‘managed care revolution’. The time, when special types of health care plans aiming to reduce health care costs (managed care) expanded with huge amount. At the end of the 1990’s almost 90% of the US population took part in some form of managed care.
But the special features of managed care (restricted choice, fixed salaries, and lower prices) were not welcomed by everyone. The public, the media and the politicians turned against managed care and end of the 1990’s was characterized by managed care backlash. Managed care was accused to pay little attention to patients in order to save costs for the institutions.
As a reason, the cost containment activities of such institutions were limited greatly by the states. Although we do not know the exact effect of managed care institutions on health care quality and prices it is not considered as a possible solution for rising health care spending. To fill this gap I collected the most important theoretical and empirical investigations on the impact of managed care.
The structure of my paper is the following. First I identify the trend of heath care costs over time, compared to other countries. Then I present an investigation of possible heath care cost ...
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... health care trend. I found that while former, theoretical analyses do not attributed the cost stagnation to the effect of managed care, newer estimations find strong evidence on price decreasing effect of it. The latest investigations could control for all the special characteristics and systematic differences between the managed care and the traditional insurance companies. For this reason Pinkovsky’s results are the most reliable evidence on the impact of HMOs.
If we accept the price declining effect of managed care, the states should build down the regulations of managed care institutions. However, better information of the population and the health sector actor is crucial to avoid the previous misinterpretations. Moreover, the managed care institutions have to be incentivized to create contracts that are available and acceptable for less healthy people also.
Due to the Patient Protection and Affordable Care Act signed into law on March 23rd, 2010; health care in the US is presently in a state of much needed transition. As of 2008, 46 Million residents (15% of the population) were uninsured and 60% of residents had coverage from private insurers. 55% of those covered by private insurers received it through their employer and 5% paid for it directly. Federal programs covered 24% of Americans; 13% under Medicare and10% under Medicaid. (Squires, 2010)
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
During the study of various reforms that were proposed and denied, both the GOP and Democrats attempted to find a balance that would guarantee the success of their proposals. Years of research, growing ideologies, political views and disregard for the country's constitution sparked an array of alternatives to solve the country's healthcare spending. The expenditure of US healthcare dollars was mostly due to hospital reimbursements, which constitute to 30% (Longest & Darr, 2008). During the research for alternatives, the gr...
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
Reese, Philip. Public Agenda Foundation. The Health Care Crisis: Containing Costs, Expanding Coverage. New York: McGraw, 2002.
In order to fully understand the uninsured and underinsured problem that hospital administrators face the cause must be examined. The health outcomes of uninsured individuals are generally worse than those who are insured. Uninsured persons are more likely to experience avoidable hospitalizations, diagnosed at later stages of disease, hospitalized on an emergency or urgent basis, and more seriously ill upon hospitalization (Simpson, 2002) Because the uninsured often lack an ongoing relationship with a health-care provider, they are less likely to receive preventive care and diagnostic tests (Kemper, 2002). Many corporations balance their budget through cost cuts and other moves, but have been slammed with an increasing load of uninsured patients, coupled with reduced payments from government and private insurance programs. In 2000, 564,476 uninsured patients came through Health and Hospitals Corporations health care centers, a 30 percent increase from 1996. In the same period, Congress reduced Medicare reimbursements to hospitals, while Medicaid reimbursements to primary care clinics remained basicall...
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Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel.
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