Managed Health Care Issues

3218 Words7 Pages
bulb-icon

Recommended: Importance of quality in healthcare

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. With the high degree of variations in health care, patients can be under or over treated or even treated with the wrong treatment for their illness. These unwarranted care techniques can be categorized into three different situations. The first category of unwarranted care is the use of evidence or lack thereof, based on other medical care. The way to explain this category is that a care plan for a patient is proven effective without any proof as to why. The example given by Kongstvedt (2007) is the use of beta blockers post heart attack. Beta blockers prove to be effective in nearly one h... ... middle of paper ... ...rnational Journal for Quality in Health Care, 14(1), 5-13. Jacobson, P. (1999, July/August). Legal challenges to managed care cost containment programs: an intital assessment. Courts & Managed Care, 69-85. Kongstvedt, P. R. (2007). Essentials of managed health care. Sudbury, Mass: Jones and Bartlett. McGlynn, E, Asch, S, Adams, J, Keesey, J, & Hicks, J. (2003). The quality of health care delivered to adults in the united states. The New England Journal of Medicine, 248(26), 2635-2645. Rodwin, M. (1996). Consumer protection and managed care: issues, reform proposals, and trade-offs. Houston Law Review, 32(1319), 1319-1381 Starfield, B, Cassady, C, Nanda, J, Forrest, C, & Berk, R. (1998). Consumer experiences and provider perceptions of the quality of primary care: implications for managed care. The Journal of Family Practice, 46(3), 216-226.

Show More
Related

  • Essay On Is Healthcare A Right Or A Privilege

    926 Words  | 2 Pages

    According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth

    Read More

  • Managed Care: An Overview and Its Uncertain Future

    1114 Words  | 3 Pages

    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.

    Read More

  • The Merger of Two Competing Hospitals: A Case Study

    3362 Words  | 7 Pages

    Kovner, A.R & Knickman, J.R (2011) Jonas & Kovner’s Health Care Delivery in the United States, 10th Edition. New York: Springer Publishing.

    Read More

  • HMO Regulation

    1302 Words  | 3 Pages

    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.

    Read More

  • Health Care Costs For The United States

    767 Words  | 2 Pages

    In order to make ones’ health care coverage more affordable, the nation needs to address the continually increasing medical care costs. Approximately more than one-sixth of the United States economy is devoted to health care spending, such as: soaring prices for medical services, costly prescription drugs, newly advanced medical technology, and even unhealthy lifestyles. Our system is spending approximately $2.7 trillion annually on health care. According to experts, it is estimated that approximately 20%-30% of that spending (approx. $800 billion a year) appears to go towards wasteful, redundant, or even inefficient care.

    Read More

  • Managed Care

    928 Words  | 2 Pages

    In conclusion, managed care integrates the functions of financing, insurance, delivery, and payment within an organization. It also exercises formal control over utilization. Managed care is viewed as accepting the lowest competitive bid for services rendered. Today, HMOs and PPOs are the most common and widely used models for managed care. Although managed care is here to stay, it requires revision in some areas. Challenges that are to be faced include double agentry, fidelity, confidentiality, honesty, and vulnerability. With the help and guidance of health information professionals, managed care will continue to escalade and become better for all.

    Read More

  • The Role of the Family Nurse Practitioner

    1432 Words  | 3 Pages

    It is no secret that the current healthcare reform is a contentious matter that promises to transform the way Americans view an already complex healthcare system. The newly insured population is expected to increase by an estimated 32 million while facing an expected shortage of up to 44,000 primary care physicians within the next 12 years (Doherty, 2010). Amidst these already overwhelming challenges, healthcare systems are becoming increasingly scrutinized to identify ways to improve cost containment and patient access (Curits & Netten, 2007). “Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal.” (Bailey, Jones & Way, 2006, p. 381).

    Read More

  • Free Healthcare in the US

    1778 Words  | 4 Pages

    Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.

    Read More

  • Role of Nurses in The Patient Protection and Affordable Care Act

    664 Words  | 2 Pages

    Berman, M. L. (2011). From Health Care Reform to Public Health Reform. Journal of Law, Medicine & Ethics, 39(3), 328-339. doi:10.1111/j.1748-720X.2011.00603.x

    Read More

  • Uninsured Health Care Essay

    1401 Words  | 3 Pages

    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...

    Read More

  • Third Party Payers In Healthcare

    650 Words  | 2 Pages

    Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,

    Read More

  • The Concept Of Health Managed Care

    1040 Words  | 3 Pages

    What is the broader implication of managed care for health care services is how healthcare providers control health care cost and quality care. With all the competition to pick from and the rising cost of health care the consumers’ needs to look at all options available. The keys to manage care are the types of organizations and insurance options that include health (HMO’s) maintenance organizations, provider organizations PPO’ and POSS. The health insurance industry is big on wellness and prevention as part of managed care.

    Read More

  • Impact Of Managed Care

    3219 Words  | 7 Pages

    The public, the media and the politicians turned against managed care and the end of the 1990’s was characterized by managed care backlash. Managed care was accused of paying little attention to patients in order to save costs for the institutions. As a result, the cost containment activities of such institutions were greatly limited 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 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.

    Read More

  • Problems With the U.S. Healthcare System

    1646 Words  | 4 Pages

    The U.S. healthcare system is very complex in structure hence it can be appraised with diverse perspectives. From one viewpoint it is described as the most unparalleled health care system in the world, what with the cutting-edge medical technology, the high quality human resources, and the constantly-modernized facilities that are symbolic of the system. This is in addition to the proliferation of innovations aimed at increasing life expectancy and enhancing the quality of life as well as diagnostic and treatment options. At the other extreme are the fair criticisms of the system as being fragmented, inefficient and costly. What are the problems with the U.S. healthcare system? These are the questions this opinion paper tries to propound.

    Read More

  • Health Care Marketing Plan for Primary Care

    2855 Words  | 6 Pages

    When promoting primary health care services, there are many factors that must be considered when developing an effective marketing plan. Primary care providers are the gatekeepers of health care in the United States; many patients have to visit them before being referred to specialist providers (Bodenheimer, 2003). They are also being tasked with ensuring patients are receiving preventative services and managing more complex chronic diseases (Akinci & Healey, 2004). Recruitment of primary care physicians is challenging because they are expected to do more and are not being reimbursed proportionally for the added workload (Bodenheimer, 2003). In this paper, a group of primary care physicians in Washington D.C. is looking to research their consumer population base in order to provide them better services and recruit new primary care physicians to their practice (Colorado State University-Global Campus, 2013). A successful primary care marketing plan will recruit quality health care providers while improving consumer accessibility to their services, customer satisfaction rates, and patients’ continuity of care with their health care provider.

    Read More

More about Managed Health Care Issues

Open Document