Effectiveness Of The Care Provided For Medicaid And Medicare Beneficiaries

Effectiveness Of The Care Provided For Medicaid And Medicare Beneficiaries

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This era also witnessed the birth of utilization review outside the HMO setting between 1970 and 1985 and some of the other notable event in this decade included the retrospective analysis by the BC of western Pennsylvanian in collaboration with other health care organizations to analyses hospital claims and determine the validity of the claims. In addition, around 1970, the California medical program also created the concept of preadmission for routing hospitalization and concurrent utilization review with their state medical board (Fox & Kongstvedt, 2015; Kongstvedt, 2009).
With all the reforms going on in the private sector it is not surprising that the government was also actively in the health arena during this era, the social security amendment of 1972 authorized the Federal Professional Standard review Organization (PSRO) to review the appropriateness of the care provided for Medicaid and Medicare beneficiaries. As would be expected in an evolving health system the PSRO was replaced with Peer Review Organization (PRO). The PRO itself was in turn replaced by Quality Improvement Organization (QIO).
Also, worth noting is the development in the Indemnity insurance during the 1980s which encourage among other things, the s concept of obtaining a second opinion prior to major procedures. In addition to the indemnity insurance changes, the 1980s witnessed the popularity of worksite wellness programs such as screening for hypertension, health risk appraisal to name a few( Kongstvedt, 2009).
Manage care grows up: (1985 to 2000)
This era saw the rise of a combination of innovation, maturation and restricting of the managed care industry, the combination of these process in the industry escalated the growth of HMOs, which eventu...

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...nsurance companies continued throughout this period (Fox & Kongstvedt, 2015; Kongstvedt, 2009).
Managed health care today
Today, we have the affordable care Act leading and steering the path of the health system in the United States. There are numerous managed care plans in the market and they are all geared toward ensuring that every American resident has basic health care coverage. Some of the highlight of the care includes health benefits plan are to guaranty dependents’ coverage until age 26, health insurance plan guaranty irrespective of the health status of a person (Fox & Kongstvedt, 201).
Undoubtedly, the enactment of ACA has increased the number of insured Americans and has its problems however; I believe it will continue to evolve over many years as the public become cognizant of what they want from the current system. The ACA has created health insurance

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