There are two types of consumers; the informed and the uninformed. The patient, i.e. the consumer, is typically unaware of the total cost of health services provided to them. They may have a copay or deductible, but the explanation of benefits and outline of care comes after treatment has been rendered. This approach has made it difficult for patients to be able to “shop around” for the best prices when in most cases they are not sure what the cost treatment will be. They were, by no fault of their own, uninformed consumers due to plan designs. The plan design of the health maintenance organization (HMO) for example, “masks the true cost of care” because the consumer only pays the copay (Kongstvedt, 2007, p.474). The copay is only a part of the total cost resulting in the consumer not seeing the value of the health insurance benefit. Consumer driven health plans (CDHP) were created, partly, so the consumer becomes aware of the true cost of health care, an example is the high-deductible health plan (HDHP). The consumer has the ability to see the true cost of care (transparency) by way of paying the high deductible. Not all CDHP are high deductible plans, any plan that allows a consumer to see the true cost of care can be labeled as such resulting in the consumer being more informed (Kongstvedt, 2007, p.474). Health care carriers’ state that members who are enrolled in CDHPs have a reduction in health care costs (Munn, 2010, p.43). Proponents of CDHPs plans state that these types of plans provide incentives for healthy behaviors. The theory is that, when consumers are more aware of health costs they have a higher tendency to manage their health care better. Opponents of CDHPs argue that consumers do not have the required knowl... ... middle of paper ... ...dministering penalties when sanctions are violated. Works Cited Coates, B. E. (2004). Corporate culture, corporate mischief, and legislated ethics: The sarbanes-oxley act. Journal Of Public Affairs, 7(1), 39-58.Retrieved from EBSCOhost. Dixon, A. (2007). Personal responsibility for health and healthcare. Consumer Policy Review, 17(6), 256-260. Retrieved from EBSCOhost. Kongstvedt, P. R. (2007). Essentials of managed health care. (5th ed.). Sudbury, MA: Jones and Bartlett publishers. Munn, J. (2010). Looking beyond health reform: The future of consumer-focused health care. Benefits Quarterly, 26(1), 43-48. Retrieved from EBSCOhost. Williams, J. R., Bettner, M. S., Haka, S. F., & Carcello, J. V. (2008). Financial & managerial accounting: The basis for business decisions (14th ed).Retrieved from http://highered.mcgraw-hill.com/sites/0072996501/student_view0/.
Shi, L., Singh, D.A. (2013). Essentials of the U.S. Health Care System. Burlington: Jones &
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 One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
Ghosh, C. (2013). Affordable Care Act: Strategies to Tame the Future. Physician Executive, 39(6), 68-70.
Niles, Nancy J. Basics of the U.S. Health Care System. Sudbury, MA: Jones and Bartlett, 2011. Print.
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.
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.
The United States (U.S.) has a health care system that is much different than any other health care system in the world (Nies & McEwen, 2015). It is frequently recognized as one with most recent technological inventions, but at the same time is often criticized for being overly expensive (Nies & McEwen, 2015). In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) (U. S. Department of Health & Human Services, n.d.) This plan was implemented in an attempt to make preventative care more affordable and accessible for all uninsured Americans (U.S. Department of Health & Human Services, n.d.). Under the law, the new Patient’s Bill of Rights gives consumers the power to be in charge of their health care choices. (U.S. Department of Health & Human Services, n.d.).
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.
..., M., Thomas, E., Smolowitz, J., & Honig, J. (2007, Dec 07). Essential health care: affordable for all?. Retrieved from www.cinahl.com/cgi-bin/refsvc?jid=374&accno=2004209136
Berman, M. L. (2011). From Health Care Reform to Public Health Reform. Journal of Law, Medicine & Ethics, 39(3), 328-339. doi:10.1111/j.1748-720X.2011.00603.x
Reese, Philip. Public Agenda Foundation. The Health Care Crisis: Containing Costs, Expanding Coverage. New York: McGraw, 2002.
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,
For those considering a consumer-driven health care plan, I would recommend that they be active in the management of their own health care in order to remain healthy so that they can prevent chronic conditions that require significant medical services. I would also recommend that for those considering a CDHP, they have the income potential earnings to save money each month either through a health spending and reimbursement plan such as the HSA, FSA or HRA or a regular savings account to have available to cover the cost of the deductibles, co-pays and co-insurances. If the deductible must be paid in full up front, I would recommend that the consumer set up a payment plan with a financial counselor.
Marshall, M.H., McManus, W.W., Viele, V.F. (2003). Accounting: What the Numbers Mean. 6th ed. New York: McGraw-Hill Companies.
The quantity medical care and issue depending on citizen preference, test, and income, the cost of the treatment and care depend on the cost of expenses minimize the point of service and market price set. The expense depending on the elasticity of medical care and demand as well on this situation the arrows welfare proposition (Pauly p. 532). Information problems can lead to a range of chance inefficiencies and purposeful troubles for the establishment of health care and health insurance by markets there is particular concern about the moral-hazard problem and opposing collection as subsets of unbalanced. Some of these problems, most noticeable and markedly, the Affordable Care Act dedicated practically fully of historically increasing government involvement through the insurances. The market failures afford to cover the arrow identified that the government support and undertake the insurance under any circumstances. The economic emphasizes that an equilibrium stretched through the goods forces and merchandise prices the market problem because of other equilibrium will make contributors be better off. Welfare measure, without making another person worse off is a value judgment. The health care problem and condition is extremely objective in value, and norms by decision maker under health and economics