Each of these programs contribute to the high cost paid by the federal government to keep the welfare state running. Medicaid, for example, provides health care to low income families with dependent children, the disabled and the poor elderly. In 1994 alone, 34 million people received some 140 billion dollars in Medicaid benefits. Food stamps that are used b... ... middle of paper ... ...who collected welfare get on the programs. California, for instance, spent $289 million in 1994 on a job training program called Greater Avenues for Independence (G.A.I.N.).
First I am going to go over exactly what managed care means, as simply as possible. Managed care is an organized approach to delivering a comprehensive array of health care services to a group of enrolled members through efficient management of services needed by the members, and negotiation of prices or payment arrangements with providers. It has two main functions; first it integrates the functions of financing, insurance, delivery, and payment with one organizational setting, and it also exercises formal control over utilization. Now I am briefly going to go over the history of managed care. Managed care dates back to as early as 1882.
The UR plan activities are directly tied to Mac Audit and coverage requirements. (Spath, 2013, p.128). Purpose & Goal of Plan The purpose of the plan is to determine medical necessity, quality of care, appropriate level of care, and efficient use of resources. The plan goal is to support MPHC’s Mission, of providing quality care, improving patient safety, and reducing costs by the collection and review of data to identify under and over utilization of resources and unsure patient treatment meet best practices for the care provided. Program Structure The UR Plan Committee includes representatives from Physicians, Nursing, Administration, Quality Management, Admission and Discharge coordinators, and Health Information Management.
As Dorothy Price points out "Over its 33 year history, Medicare has channeled billions of dollars into the health care system, helping to foster enormous improvements in health care technology and medical education" (Carnegie). Unfortunately thou... ... middle of paper ... ... can and can't expect from the bill, and also analyzes some proposed solutions regarding healthcare costs. Marmor is a professor at Yale University, and has been called on by Congress several times for policy proposals and debate. He is considered an expert on health care reform. McCanne, Dr. Don.
The 21st Century President Barack Obama signed the Affordable Care Act in 2010. Its purpose was to maintain a steady health insurance policy for the masses and offer affordable, available, and better quality (Berwich & Hackbarth, 2012). “The United States spends more on health care, both per capita and as a share of Gross Domestic Product (GDP), than any other country in the world” (Center for U.S. Health System Reform, 2011, p. 1, Para 2). Conclusion The U.S. health care system has experienced many transitions over the years. It has gone from being a simple method of becoming difficult to understand.
Three areas that define the provisions of comprehensive health care services and are commonly used for utilization monitoring and control are gatekeeping, case management, and utilization review (UR). Gatekeeping is used by HMOs where each member designates a primary care provider (PCP) that is responsible for coordinating all care services needed for the enrollee in a managed care plan. Case management involves an experienced health care professional with knowledge of available health care resources. `Case management services are designed to identify spec... ... middle of paper ... ... The HIM professional may also pursue a position as chief information officer within a managed care organization.
The Vietnam medical tourism market can create many opportunities to stimulate economic progress and alleviate poverty. With the fact of almost 40 million dollars worldwide is made from businesses associated with health tourism every year, Vietnam could also make a huge profit from the medical tourism industry through selling healthcare insurance cards and providing healthcare services for medical tourists (The Economic Times, 2013). For instance, through the permission of the Affordable Care Act, almost 50 million Americans, w... ... middle of paper ... ...as-medical-tourism-industry Stuligross, J. (n.d.). The Affordable Healthcare Act: Reducing Waste, Improving Efficiency, Reducing Costs.
Managed Care Organization A managed care organization is a collection of clinics, doctors, hospitals, pharmacies and other healthcare providers who come together to offer health care to persons who are sign up for the services. In many cases, managed care organizations operate and are referred to as networks of health care providers. Managed care organizations are comprised of health care experts from different fields who come under an agreement to offer health care services to members. Once a member signs up, all their heath care needs are covered by the managed care organizations. Access to care outside the organization is restricted.
Researchers found that, over the last 15 years, preventable illness or disease makes up 70 percent or more of the total health care cost (Hall, 2008). Employers intend to use the program to reduce such preventable health risk, which can lead to expensive chronic diseases and high insurance costs. “According to a 2008 national survey by Harris Interactive, 91 percent of employers ‘believed they could reduce their health care costs by influencing employees to adopt healthier lifestyles,’ wrote two Harvard School of Public Health (HSPH) experts”(Mello and Rosenthal 2008). An early proponent of such program, Johnson & Johnson, has greatly reduced its health care cost by adopting the program. The company estimates that wellness incentive programs have cumulatively saved Johnson & Johnson $250 million on health care costs over the past decade, and the return was $2.71 for every dollar spent from 2002 to 2008 (Berry, et al.
The first healthcare system occurred during Mao Zedong’s regulation in 1949, and for the first time, healthcare system was under central government’s control. With 95 percent of population under poverty line, Chairman Mao saw the need to improve people’s health, therefore create a stronger nation. Rural Cooperative Medical System was the contribution to rural residents. Allowing resident to pay on monthly wages, individual was able to get some support from government and seek for medical sup... ... middle of paper ... ...e Amid Explosion of Elderly. Bloomberg.com.