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.
A caregiver’s perspective about managed care is it offers some stability in patient load and income. Managed care would help cut some of the caregiver’s expenses of maintaining facilities and staff, by uniting caregivers and sharing resources. Managed care may also help health care organizations run more efficiently and effectively. The disadvantage is a loss of professional independence and, an increase financial risk. According to the text “Capitation is especially risky because providers receive a set fee no matter how much care is needed.” A great deal of vigor in managed care is focused on paperwork, authorizations, and procedures, and caregivers say it is nearly unattainable to do their jobs efficiently and meet the increased demand for paperwork.
Which would I prefer traditional insurance or manage care? Well this is a very tough question for me. I have had both, when traditional insurance was on the rise during the late 90’s, my ex-husband and I had very affordable insurance for a very reasonable price. We had no deductable, we could see who we wanted for caregivers, a ten dollar co-pay, and reduced prescriptions. Today I am on Medicaid (not for elderly but for poor), but I don’t think I could afford today’s insurance prices. I like Medicaid because I don’t have to worry about money for doctor’s bills, co-pays, or prescriptions. On the other hand I have a tough time finding caregivers accepting new Medicaid patients, some doctors treat Medicaid patients differently, many treatments and prescriptions ordered are not covered by Medicaid, so I had to go with out.
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
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
The pros of PPACA include providing insurance to the "32 million" people that do not have insurance (Amadeo). These are the people who consistently show up in the "emergency room" and usually do not pay their bill, creating a rise in the cost of health insurance for everyone else (Amadeo). The law requires all insurance plans to cover certain preventative care in order to diagnose illnesses before they reach the costly state (Amadeo). PPACA also makes coverage available to those with pre-existing conditions (Amadeo). This has been an issue in the insurance industry because of adverse selection, which is caused when insurance is purchased by those who will use more than what they are paying (Stone 85). Insurance companies would off-set their costs by offering several plans with different deductibles or co-pays based on asymmetric information (85). PPACA will protect individuals from cost increases because of a pre-existing condition (Tate 14).
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.
Universal health care refers to any system of health care managed by the government. The health care system may cover different programs including government run hospitals and health organizations and programs targeted at providing health care. Many developed countries such as Canada and United Kingdom have embraced universal health care with the United States being the only exception. The present U.S health care system has often been considered inefficient in terms of cost control as millions of Americans remain uncovered. This has made it the subject of a heated debate characterized by people who argue that the country requires a kind of socialized system that will permit increased government participation. Others have tended to support privatized health care, or a combined model of private and universal health care that will permit private companies to offer health care for a specific fee. Universal healthcare has numerous advantages that remain hidden from society. First, the federal government can apply economies of scale in managing health facilities which would reduce health care expenses. Second, all unnecessary expenses would be eliminated by requiring all states to bring together all the insurance companies into a single entity whose mandate would be to provide health insurance to all people. Lastly, increased government participation will guarantee quality care, improve access to medical services and address critical problems relating to market failure.
Formed in 1998, the Managed Care Executive Group (MCEG) is a national organization of U.S. senior health executives who provide an open exchange of shared resources by discussing issues which are currently faced by health care organizations. In the fall of 2011, 61 organizations, which represented 90 responders, ranked the top ten strategic issues for 2012. Although the issues were ranked according to their priority, this report discusses the top three issues which I believe to be the most significant due to the need for competitive and inter-related products, quality care and cost containment.
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. Members under managed care organizations are usually assigned a primary care physician (PCP) who is the primary care giver for the member. The PCP is tasked with analyzing a member’s health problem before referring them to other sections of the managed care organization. Managed Care Organizations are usually well coordinated to meet the needs of members who have registered under their banner.
Implemented (along with Medicare) as a part of the Social Security Amendments of 1965, Medicaid’s original purpose was to improve the health of the working poor who might otherwise go without medical care for themselves and their families. Medicaid also assisted low income seniors with cautionary provisions that paid for the costs of nursing facility care and other medical expenses such as premiums and copayments that were not covered through Medicare. Eligibility for Medicaid is usually based on the family’s or individual’s income and assets. When the ACA came into effect in 2010, it began to work with the states to develop a plan to better coordinate the two ...
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.
Medicare and Medicaid together "are the single biggest contributor to [the United States] long term [budget] deficit." This idea was expressed by President Obama during his 2011 state of the Union Speech. After saying this, the president said that health care costs need to be reduced, including these two services. Medicare and Medicaid are beneficial to those who receive their services, and the criteria for eligibility currently allow many to qualify for either program. This is most likely the cause of the major deficit that the president spoke of. However, downsizing or eliminating these programs to lessen the deficit will affect many people and their ability to receive healthcare.
From the individual perspective mandating the health insurance will firstly make the individual be independent rather than relying over the society and whatever cost of medical treatment due to catastrophic events the insured faces in his future will be covered by the Health Insurance and he has to bear very less cost of the medical treatment. And also those services will be there whether the person gets sick or not.
Medicaid is a broken system that is largely failing to serve its beneficiary’s needs. Despite its chronic failures to deliver quality health care, Medicaid is seemingly running up a gigantic tab for tax payers (Frogue, 2003). Medicaid’s budget woes are secondary to its insignificant structure, leaving its beneficiaries with limited choices, when arranging for their own health care. Instead, regulations are set in order to drive costs down; instead of allowing Medicaid beneficiaries free rein to choose whom they will seek care from (Frogue, 2003)
Medicare and Medicaid are programs that have been developed to assist Americans in attainment of quality health care. Both programs were established in 1965 and are federally supported to provide health care coverage to vulnerable populations such as the elderly, the disabled, and people with low incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is Medicare? What is Medicaid?” 2008).
...ue to be manageable. Additionally, the Medicaid system leaves much open room for users to commit fraud undetected. Medicare would be a more ideal system if costs were based like those of the Medicaid system; many times the Medicare population are on limited incomes, so small co pays and lower medical costs would be more ideal.
Arguably, all three situations met by the end of the 20th century. The rise of managed care, the increase of health care costs, and the growing number of uninsured patients place economic and political pressures on individuals (and governments) to find a cost-containment resolution. Additionally, since the late 1970s, the medical profession has faced the dominating principle of patient independence as a challenge – first to medical paternalism and then extending even to the principle of beneficence. More so, the usage of the Internet and other global media has expanded the ability of patients to access an...