Introduction of Managed Care Managed care is one of the leading form health care in the United States. It has become very popular and many people in the United States have taken advantage of it. There are a few different types of managed care programs: Health Maintenance Organizations or HMOs, Preferred Provider Organizations or PPOs, and Point of Service Plans or POSs. Each one of these types of managed care plans has its pros and cons (Cyrene, 2015). If you would ask a few people what types of insurance they have, they are more than likely going to name off a managed care plan because it is more common to find someone with a managed care plan than not. Managed care has changed the healthcare system in many ways, some for the good and …show more content…
They really look out for the best for the patient and make sure that they are receiving the best quality of care by their physicians. One major benefits of managed care is that they have lower costs for you as the patient. You typically think that if you pay less you are going to get less, however with managed care they want you to pay less but still receive the same quality of care. Managed care plans keep the costs down by contracting with providers and referring these providers to their patients. Employers tend to lean towards these types of benefits. That is why many employers have switched to managed care plans (Cyrene, 2015). Under most managed care plans, they encourage their patients to get annual preventive physicals and get early treatment when sick so it doesn’t progress into something more (University Human Resources, 2015). For patients under managed care plan providers are always readily available to them. All these healthcare providers are all credentialed (Cyrene, 2015). Managed care plans also lower the prices on prescriptions for their patients as well. Managed care plans typically lean towards providing the generic prescriptions and lowering their copays too (Jackson,
Kaiser Permanente’s mission is to provide care assistance to those in need. As a health maintenance organization, Kaiser Permanente provides preventive care such as prenatal care, immunizations, diagnostics, hospital medical and pharmacy services. Also, they take responsibility and provide exceptional training for their future health professionals for better clinical performance and treatment for the patients. The organization is to ensure fair and proper treatment towards their employees for a pleasant working environment in hospital and to provide medical services especially in a growing population in suburban communities, such as Tracy and Stockton in California.
What is managed care? According to the Oxford English Dictionary, managed care is “a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” Managed care is a variety of techniques designed to reduce the cost of providing health benefits and advance the quality of care. In the United States alone, there are various managed care programs, that are ranged from more restrictive to less restrictive. As stated in the National Institutes of Health, the future of managed care is uncertain. 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
The United States is projected to spend nearly 20 percent of the Gross Domestic Product on healthcare by 2020.According to a Mckinsey study $447 billion of the 1.7 trillion the U.S. spent on healthcare in 2003 was in excess of what it should have spent based on its wealth. A 1 % increase in the rate of health-spending results in an increase of about $2 trillion in spending on health over the next 10 years.
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.
HMO's can and do conduct their business quite ruthlessly. Patients are continuously unable to receive the necessary treatment due to the insufficient HMO coverage. Many HMO's actually make more money if their doctors see or treat fewer patients. According to the Associated Press, “Consumers who have been denied a treatment that the HMO says is not covered, or who inadvertently fail to follow HMO guidelines in seeking treatment and are therefore denied reimbursement, will continue to have little recourse.” (2) Many people must drive for hours, generally sick or injured, simply to receive treatment from a doctor that will be covered by their HMO.
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.
Medicare was designed as a universal healthcare program for individuals 65 years old and older. This program is funded by Medicare taxes and general federal funding withholding taxes. Medicare is a partnership between federal and state with the goal to provide medical insurance to the elderly that is poor and disabled. Generally all people who are 65 years or older and qualify for social security will automatically qualify for Medicare.
In the event that you would like the least expensive strategy and do not thoughts your own physicians becoming selected for your needs, after that a good HMO is actually exactly what your own in need of. If you would like much more independence of preference compared to a good HMO as well as are prepared to spend a bit more for an insurance coverage, a PPO constitutes an option. And when you are the older as well as wish to health supplement your own Medicare insurance insurance coverage, a Medicare insurance health supplement is actually things you
There are several issues concerning the uninsured and underinsured patient population in America. There are many areas of concern the congressional efforts to increase the availability of health insurance, the public image of the insurance industry illustrated by the movie "John Q", the lack of good management tools, and creating health insurance coverage for all low income Americans. Since the number of uninsured Americans has risen to 43 million from 37 million in the flourishing 1990s and could shoot up even more severely if the economy continues to decrease and health care premiums keep increasing (Insurance No Simple Fix, 2001).
Obamacare: the Temporary Solution to an Evolving Issue The need for universal health care within the United States has been evident, and needs to be addressed. The old healthcare system was plagued with issues, including expensive premiums that were on the rise, along with an inflated average infant mortality rate and limited average life expectancy, which ultimately led to many people being left uninsured (“Affordable” 2). In the 2012 presidential election, one key issue was how to reform America’s broken health care system, and to instate a successful universal healthcare system that has resolved the previous issues. Being one of the last influential and competitive countries in the world without universal healthcare, the pressure was on for the United States to develop its own system.
Many residents in the United States receive healthcare through various forms, such as insurance’s, Medicaid or Medicare. Medicaid is health care for the low income including children, pregnant women, disabled, blind and elders (Adams). According to the Congressional Budget Office there are about 51 million people that are covered by Medicaid and also it the largest drain on state budgets (Adams). Most countries have some type of form of health care they provide, for example, Japan is a democratic country that provide health care, but is different from other countries. There are also many interest groups that either agree or disagree with expanding Medicaid. The New Hampshire (NH) Community Behavioral Health Association and the American Association of Retired Persons (AARP) are two of the many interest groups that are in favor of expanding Medicaid’s spending, as well as RTI International. However, Ohio Right to Life and Cleveland Right to Life are interest groups that oppose the expansion of Medicaid.
Medicare is a national social insurance program, run by the U.S. federal government since 1966 that promises health insurance for Americans aged 65 and older and younger people with disabilities. Being the nation’s single largest health insurance program, covering a large population for a wide range of health services, Medicare's funding is a fundamental part of it sustainability. Medicare is comprised of several different parts, serving different purposes, some of which require separate funding. In general, people at the age of 65 and older who have been legal residents of the United States for at least 5 years are eligible for Medicare. Same is true with people that have disabilities under 65, if they receive Social Security Disability Insurance benefits. Medicare involves four parts: Part A is hospital insurance. Part B is additional medical insurance, that Part A doesn't cover. Part C health plans, also mostly known as Medicare Advantage, are another way for original Medicare beneficiaries to receive their Part A, B and D benefits. Medicare Part D covers many prescription drugs, some of which are covered by Part B. Medicare is a major operation, not only needing adequate administering but the necessary allocated funds to keep this massive system afloat.
Access to health care refers to the ease with which an individual can obtain needed medical services. Many Americans face barriers that make it difficult to obtain basic health care services. These barriers to services include lack of availability, high cost, and lack of insurance coverage. "Limited access to health care impacts people's ability to reach their full potential, negatively affecting their quality of life." (Access to Health Services, 2014) Access to health services encompasses four components that include coverage, services, timeliness, and workforce
...ue to numerous medical errors. With the amount of medical errors that currently do occur which is a current health care issue it cost the health care billions of dollar each year to fix the mistakes that were made.
Health care has always been an interesting topic all over the world. Voltaire once said, “The art of medicine consists of amusing the patient while nature cures the disease.” It may seem like health care that nothing gets accomplished in different health care systems, but ultimately many trying to cures diseases and improve health care systems.