The Morality of Managed Care
"The preservation of health is a duty" according to Herbert Spencer, an English philosopher (Andrews, 1993). Managed care conglomerates provide health coverage for increasing numbers of Americans. Many critics question whether these businesses provide care dutifully. At the very least, the present managed care system requires health care providers and recipients to reexamine established principles underling physician-patient interaction.
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.
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.
Managed care is often seen primarily as a cost cutting initiative that is concerned with managing cost and cost only in the healthcare field. For this and a few more reasons managed care organizations face severe judging on the quality of care that they provide. When analyzed correctly, trends prove that managed care has in fact been very significant in determining and improving the quality of care. In this paper, elements such as the state and federal oversights over MCOs, voluntary accreditations, standardized performance indicators and examples of successful quality programs developed by MCOs will be used to prove this statement. Though in the eyes of many managed care and quality do not go together, the research information provided in this paper will show that MCOs are placing more emphasis on measuring and improving the quality of healthcare and therefore should be considered as an important force in such.
meaningful exploration of the impact of health care delivery market place changes and current legislative reforms on the essential tenets of the patient-physician relationship. According to President Clinton’s original reform proposal it addressed in broad terms the ethical imperatives supporting total access, it left virtually unexamined more fundamental question of the role of the physician in a reformed system where budgets determine the amount of health care spending, services, and the incentives that are dramatically changing (Ethic Issues n.d ). In June of 1990 the council met and issued a report on, "Financial Incentives to Limit Care: Financial Implications for HMOs and IPAs, It described the financial incentives that managed care plans proposes to physicians to limit their provision of care (Policy 140.978, AMA Policy Compendium). The report concluded that patient welfare must of course remain priority while physicians continue in working in HMOs and IPAs and that physician must expose contractual boundaries that affect the sending of health care to patients and all related financial inducements. With the importance on managed competition and managed care, health care reform will greatly intensify the ethical concerns greater by managed care. It is therefore important that the society and professionals act now to guarantee that managed care techniques are applied in a way that protects the integrity of the patient-physician relationship and the patient (Ethical Issues n.d). To effect physician behavior monetary incentives are normally used , and may entail of fulfilling physicians who practice medicine cautiously by offering financial payments, such as advantages for those who provide the most cost-efficient care. A f...
The advantages of managed care to the consumer are medical expenses completely covered, no deductible, and lower monthly premium payment. The consumer under managed care coverage would only need to make his monthly premium payment and co- payments. Managed care makes health care more affordable to the consumers. The disadvantages of managed care would be the consumer would only be able to see caregivers affiliated with the managed care organization, having to pay co-pay every visit, rising premiums, under treatment, and too much reed tape to get necessary treatments.
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
Martin Luther King Jr. stated that, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” (Munro). Today, the availability and quality of healthcare for everyone is based on the amount of wealth one has. With the creation of websites like gofundme and many others we see the financial burden that is put on so many families with sick ones. It all comes down to wealth, if you have the money to cover extreme medical cost, you will be able to get better, continue on with work and continue making money. However, the people who can’t afford to get better? Those people get worse, eventually affecting their ability to work and bring in money, and in the end, they are getting sicker and poorer.
Managed care is a hard and complex organization. Managing an organization day today is a hard task but having individuals throughout the organization providing excellent service will help keep the organization at an all-time high with profitability and viability. It takes time for an organization to have a successful business and to have a better understanding of account budgeting. Most health care organizations use planning and budgeting functions to help a there organization succeed in identifying goals and objectives to make sure their organization stays on a task of improvements. Planning and budgeting play a big role in organizations to make sure that the organizations are establishing the goals they want to achieve as well as financial
In the past when there were no managed care plans the beneficiaries would be allowed to go to any doctors, now because of managed care they have one primary doctor who manages their care and refer them to other types of doctors if necessary. Managed care has its pros and cons, in one way it is good to have one doctor taking care of you all the time but at the same time it is very restricting when you either want or must go outside of your network. In my opinion, I do not care for managed care because of an experience I had over 20 years ago. My daughter was a child and had an asthma attack, the ambulance took me to a nearby hospital but when I called to alert my managed care on her condition, they told me I had to go to another hospital that