Criticisms Of Managed Care
analytical Essay
1003 words
Introduction Managed care plans present as forms of health insurance covers. These plans have contracts with medical facilities and health care providers to offer care for clients at decreased costs (Dixon, Greene & Hibbard, 2008). This paper will discuss the criticisms that have been addressed regarding managed care, and the different features that are included in a CDHP. Additionally, it will discuss the existing differences between the choice of providers, cost sharing, and covered benefits of HMOs and CDHPs. This will help in drawing conclusions regarding the latest information that surrounds managed care. Criticisms/Drawbacks of Managed Care Ethical and Legal Issues In worst case settings which, incidentally, take place more frequently …show more content…
In this essay, the author
- Explains that managed care plans are forms of health insurance covers that have contracts with medical facilities and health care providers to offer care for clients at reduced costs.
- Analyzes how the establishment of managed care has been evidenced to be technically, contentious, philosophically difficult, and politically fragile. the organization for evaluating the given care quality is under attack for lack of being adequately autonomous.
- Opines that the rise of healthcare makes it harder for people to afford healthcare.
- Explains that in worst case settings, the delivery is standardized by inexperienced managers in offering care at the least possible cost. corporate objectives connect more to bending a market and keeping off the competition rather than to offering first class health care.
- Argues that the american healthcare system is badly broken and is in the grip of a bid industry that will never stop making money.
Physicians hold responsibilities to their personal patients, but also responsibilities to the patient populations for whom they are held accountable (Rhodes, Francis & Silvers, 2007). Additionally, they are expected to advance and support the growth of medical science. Nevertheless, the most recent criticism has been accorded to the allocation of resources. As much as physicians are appropriate or designated communal resource custodians, they need to be conscious of the quality or cost of medical care. The American healthcare system is badly broken, we are in the grip of a very bid industry that will never stop making money. The healthcare aspect of today economy depends on the financial aspect. You cannot get or receive medical care without insurance. Some people are offered free healthcare which tax payers pay for. This help people who or poor, low income or middle class however. I will write about why the healthcare industry is such a financial burden to poor, middle class and pre-condition people. How the medical industry charge $1,500 for 5 minutes for someone to put a needle in you but $15 for 45 minutes for someone to exam …show more content…
We don’t have a healthcare system in America that care for people it’s a number game based on how many people are seen. The more medication a person is on the more money the heath care makes. We will never have single-payer or universal healthcare because the insurance companies. I work for a home health care company and I am not happy I am pissed off every day knowing there are so many people out there that need our help but due to the fact they don’t have Medicare we must refuse those people.99% of home health care companies are like this. Who really care for people that are sick. In Africa if you have no money the doctor won’t see you they hospital will leave you outside to die. I feel as if America is not that different from Africa the rise of healthcare make it often hard for people to afford healthcare, I have a friend who has Medicare and she is on a fix income with COPD and several other illness and was told as of 2017 the will deduct more money from her ssi check and she stated if they do that she won’t be able to pay her bills and she will have to go without healthcare
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- The Morality of Managed Careanalytical essayThe 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.
In this essay, the author
- Argues that managed care conglomerates provide health coverage for increasing numbers of americans, but critics question whether they provide care dutifully.
- Explains that managed care plans have dominated the marketplace since the early 1980's. ppos contract with a limited number of physicians and hospitals, while hmos amass insurers and providers.
- Explains that in the united states, four main principles undergird the way health care is practiced.
- Opines that financial considerations make decisions even more difficult in today's monetarily driven health care environment. the united states has maintained high standards of quality in technological advancements and treatment possibilities.
- Argues that medical ethics must adopt sound business and management techniques, but do they seek conflicting ends?
- Explains that risk rating is the practice of setting premiums and other terms according to the age, sex, occupation, health status, and health risks of policyholders.
- Explains that there are several forms of risk-based insurance, including direct risk rating and indirect risk ratings.
- Argues that risk rating supports an inverse coverage law and discrimination, arguing that individual patients with costly illnesses are a financial liability, and patients in good health are financial advantages.
- Explains that risk rating is the belief that it is unjust to force one person or group to pay for the needs or burdens of others.
- Argues that insurers are consciously or unconsciously assuming that the purpose of the health insurance market in society is to allow those who are younger, affluent, constitutionally more sound, and healthier to pursue their advantage of lower risk.
- Explains that risk rating is one of the tools that managed care plans use to create a profitable enterprise. it is important to examine the effects of these actions on health care recipients.
- Opines that managed care should provide medical care to a larger segment of society at reasonable expense, but will the patient's quality of care deteriorate?
- Analyzes the benefits offered to seniors by one major hmo. the innocent-sounding phrase, "when medically necessary," suggests more expensive services will be provided.
- Opines that the most effective way to examine how patients will be affected by managed health care would be by examining how healthcare providers are required to operate. providers interests are increasingly divided between financial incentive and patient interest.
- Opines that doctors are increasingly responsible to insurance companies. in today's managed care environment, insurance agencies are paying physicians capitation payments.
- Opines that physicians' divided interests are not the only issue with which citizens have concern. under present law, hmos must not disclose how they pay their physicians or how physicians must make decisions.
- Explains that hmo's are using high pressure tactics to keep physicians "in line." they scare physicians into treating patients under certain guidelines.
- Explains that when the care in a community becomes heavily capitated, many physicians are forced to join managed-care plans or be left without patients.
- Opines that although one may feel little empathy for these physicians, patients will be the ones who are eventually affected by this treatment.
- Analyzes how dr. kassier questioned the role of research and educational institutions in medical specialties.
- Opines that the country cannot afford to spend a larger percentage of its income on health care, and physicians and patients cannot maintain honest relationships under many managed care plans.
- Explains kassirer, jerome p., "managed care and the morality of the marketplace," the new england journal of medicine, july 6, 1995, pp.
- Explains light, donald w., "the practice and ethics of risk-rated health insurance." the journal of the american medical association, 1992, pp. 2503-2508.
- Analyzes peliegrino, edmund d., "ethics." the journal of the american medical association, june 1, 1994, pp. 1668-1670.
- Cites shenkin, budd n., "the independent practice association in theory and practice." the journal of the american medical association, june 28, 1995, pp.
3319 wordsRead More - Managed Carecomparative essayManaged 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.
In this essay, the author
- Explains that managed care is differentiated by definition, operation, structure, and information needs. the pos combines characteristics of hmos with patient choice features in ppos.
- Explains the role of the health information management professional in managed care.
- Concludes that managed care integrates the functions of financing, insurance, delivery, and payment within an organization and exercises formal control over utilization.
- Explains that managed care is a health care delivery system that combines the functions of health insurance and the actual delivery of care.
928 wordsRead More - The Concept Of Health Managed Careexplanatory essayWhat 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.
In this essay, the author
- Explains the broader implication of managed care for health care services is how healthcare providers control the cost and quality of care. the health insurance industry is big on wellness and prevention.
- Explains that manage care is a health care system that manages cost and quality care services. these techniques were created by health maintenance organizations, but with mixed results in controlling healthcare cost.
- Explains that managed care is constantly changing; the cost goes up no matter what but some organizations have discounted prices for their services to beat their competition.
- Explains managed care is an insurance that goes along with financing and quality health care. medicaid and hmo's one of the biggest problems is finding doctors that are in the network.
- Explains that medicaid hmo's don't report information so that there is no information that consumer can compare.
- Explains that an hmo enrolling medicaid patients could have a higher cost if there is no competition and providers fail to give the medicaid patient key services.
- Explains that hmo's are designed to keep the cost of health care from rising, but still give care to those that need it. the doctor is given a set amount of money.
- Explains that doctors have legal and ethical obligations to provide adequate medical treatments and quality care no matter what their contract is with the hmo.
- Explains that hmos want to keep costs down by preventative medicine and wellness programs. quality care is still there, but the control unnecessary treatments.
- Explains that doctors, hospitals and insurance companies are encouraging patients to get exercise, watch their diets, keep active, and have wellness and preventive medicine checks every six months or what their doctor suggests.
- Explains that medicare advantage (ma) is also medicare part c. the premiums for medicare advantage prescription drug plans are about $53.00 which is a $3.00 increase from 2014.
- Recommends checking the monthly premiums for hmos plans before taking a health care plan or going with it.
1040 wordsRead More - Managed Care and Quality Improvementanalytical essayManaged 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.
In this essay, the author
- Explains that managed care is often seen as a cost cutting initiative that is concerned with managing cost and cost only in the healthcare field.
- Explains that the managed care industry is governed and handled by for-profit organizations, which leads many to believe it focuses more on managing costs and obtaining profit than in the quality of care provided to individuals.
- Argues that managed care does not improve the quality of care because performance indicators for such are low in populous states and high in less-populous ones.
- Explains how the improvement of preterm infant care within the managed care spectrum can be used as an example of how plans have improved the quality of healthcare.
- Argues that managed care organizations play a very important role in the healthcare system and the care it delivers to beneficiaries and patients. partnerships and compromises between mcos, hospitals, insurance companies, health plans, practitioners, consumers and purchasers must be made to fill in gaps.
1296 wordsRead More - nay paperanalytical essaymeaningful 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...
In this essay, the author
- Analyzes the impact of health care delivery market place changes and current legislative reforms on the essential tenets of the patient-physician relationship.
- Explains that a fine can occur if cost-efficient or too many procedures are performed by those who implement them. the congressional budget office has resolutely stated that the patient protection and affordable care act is fully compensated for.
- Explains that the affordable care act abolishes lifetime and unreasonable annual limits on benefits such as rescissions of health insurance policies, support for those who are uninsured because of a pre-existing condition, stretch the dependent coverage until the age of 26, and caps insurance company non-medical, administrative expenditures.
- Analyzes the difference between ethical utilitarianism and utility, stating that the public health service is pushed to the utiliarian choice to treat more individual and save money.
- Opines that the healthcare industry is a field where it will always change constantly. ethical utilitarianism embraces that any health institution should help as many individuals as possible.
1097 wordsRead More - Managed Careopinion essayThe 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.
In this essay, the author
- Explains the advantages of managed care to the consumer, such as medical expenses completely covered, no deductible, and lower monthly premium payment.
- Opines that managed care offers stability in patient load and income, but the disadvantage is a loss of professional independence and an increase in financial risk.
- Opines that they prefer traditional insurance or manage care because they don't have to worry about money for doctor's bills, co-pays, or prescriptions.
413 wordsRead More - Benefits Of Managed Careexplanatory essayManaged 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
In this essay, the author
- Explains that managed care has impacted their personal health care insurance provider choice because of employer, plan options, and affordability of coverage.
283 wordsRead More - Essay On Substandard Careanalytical essayMartin 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.
In this essay, the author
- Opines that the availability and quality of healthcare for everyone is based on the amount of wealth one has. those who can't afford to get better get sicker and poorer.
- Explains that 80% of non-communicable diseases are in low- and middle-income families, and that many people rely on insurance, if they have it, or the help of others to pay for medical costs.
- Analyzes how gofundme has provided relief for families, whether once or multiple times. hanna olson and her family raised $6,000 for her treatment of a rare paraganglioma tumor.
- Explains that the united states spends more per capita on healthcare than any other nation, but it also causes health care costs to soar.
- Explains that if a family or individual can't afford medical care, they are subjected to substandard care and go home to live in poor housing and degraded environments.
- Explains that medicaid is a state and federal program that provides health coverage if you have low income, but it comes with high prices, and even patients find it difficult to access the health care system.
- Explains that the wealthy have more access to health care, while the poor are left working multiple jobs, and nutritionists and personal trainers, allowing them to eat better and work out more efficiently.
- Explains that the average american spends $7,900 per year on health care, and lower-income families have a lower life expectancy.
1763 wordsRead More - The Importance Of Managed Careexplanatory essayManaged 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 this essay, the author
- Explains that managed care is a hard and complex organization, but having individuals providing excellent service will help keep it at an all-time high with profitability and viability.
219 wordsRead More - Managed Care: The Pros And Cons Of Managed Careopinion essayIn 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
In this essay, the author
- Opines that managed care has its pros and cons, but it is restricting when you either want or must go outside of your network.
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