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Impact of managed care on individual's healthcare
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Managed care has impacted my own personal health care insurance provider choice because of employer, plan options, and affordability of coverage. According to, (Bundorf et al., 2004), the actions taken by managed care organizations to influence treatment patterns for their enrollees may also affect the types of treatments received by patients not enrolled in these plans. My current job in 2015, all employees were only offered Aetna which $350-$500 is taken out each month. Unfortunately, this dental practice has one plan to offer and not a couple plans for employees to choose from. One year later, my employer gives the option for employees to choose a less expensive plan for healthy employees and save more money. Some employees still have
This could be controversial, if older, sicker people who need the coverage most enter the market, but younger groups decline to do so. The insurance pool will be unbalanced and the cost of coverage will rise correspondingly. The process of choosing a health insurance provider should be more consumer friendly. People covered by their employer can clear their doubt about health insurance by conversing with the Human Resource department, whereas people who buy through marketplaces or health insurance exchanges, as in the case of ACA, may not have any resource to give further explanation.
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
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.
CDHP can be defined narrowly as health care aimed for customers, and refers to insurance plans in health that give members opportunity to use their health savings accounts , health reimbursement accounts, or similar medical payment plans to pay routine healthcare expenses directly. Health plan that are highly deductable cushion individuals from disastrious medical costs. The highly deductible health care plan is cheaper but is characterized by routine payment of medical premium using prefunded account by a debit card or insurance payment plan (Buntin, Damberg, Haviland & Kapur, 2006).
You want information about health insurance and you would like to have it in a easy to understand format. If this is the case, this article will be perfect for you. We will lay out some of the most important tips and guidelines in a way that you can quickly digest.
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.
Prior to the passing of the Affordable Care Act (ACA), some employees were receiving plans that had poor coverage or had other barriers to accessing care, which affected individual who have a costly, chronic health conditions by having large bills and uncovered medical care. When the ACA passed in 2010, there were a few changes that impacted employee based insurance. Some of the changes include preventive services without cost sharing, pre-existing conditions exclusions, dependent coverage to age 26, annual out of pocket limit and prohibition on annual and lifetime limits. The ACA provided health plans to cover recommended preventive services without cost sharing. Individuals are able to receive screenings, immunizations and annual check ups
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.
Everyone though out the United States are being to have some sort of health insurance since legislations passed the patient protection affordable care act that began in the beginning of 2014. The reform act basically states all people have to have some type of health insurance and if they fall to have the minimal required insurance then will face a tax penalty. However, with the written laws the information is difficult to understand and even more difficult to interpret what the impact will be if people fail to comply and get insurance (Suelzer). Although the coverage is mandatory there is a loophole in the act making some people exempt from being required to have health insurance. Individuals who have a religious belief,
for Medicare, you must meet certain conditions. A person qualifies if they are 65 years of age
Ans 1) To mandate the insurance or not is a big question to be answered and still there are a lot of problems associated with mandating the Health Insurance in United States. A lot of views have been given by people regarding whether there is need of mandating the Health Insurance or not.
Khalia Groves Amelia Decker Senior Project 18 February 2014 The Effects of the Affordable Care Act Throughout the years, there have been many individuals and families who have not been able to afford healthcare. Some programs have helped to provide for those in need, but they have not provided to all needy citizens. In an effort to provide more people with the healthcare and insurance they truly need, the United States government has developed the Affordable Care Act. The act’s purpose is to expand Medicare, which was originally developed to provide for the elderly and the disabled, to those who are not disabled but are in times of financial hardship.
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,
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,
Managed health care actually combines health care delivery with the financing of services provided. This was intended to replace conventional fee-for service plans with much more affordable quality of care to the health consumers as well as the providers who was in agreement with the restrictions. However, managed care is becoming challenged due to the growth of consumer-directed health plans, which defines employer continuations and asking employees to be more responsible within their health care decisions and cost-sharing. The Americans health care system has been changing the way their health care services are organized and delivered. As seen by the movement from traditional fee-for-service systems to managed care networks. Ranging from structured staff model HMOs to the lesser structured preferred provider organizations (PPO). Statistics show that 60 million Americans are enrolled with some type of managed care program within the response to regulatory initiatives which affect health care cost and quality. Managed care organizations are responsible for the health of their enrollees, which can be administered by a physician’s group, health system, or even a hospital. Much of the managed care financing is through a method called capitation, and the enrollees are assigned to a select primary care provider, which serves as a gatekeeper.