Ethics In Managed Care

Managed care is a system of healthcare delivery that seeks to achieve efficiency by interpreting the basic functions of healthcare delivery. It employs mechanisms to control (manage) utilization of medical services and determines the price at which the services are purchased and how much the providers get paid.

Managed Care is a system of health care in which patients agree to visit only certain doctor and hospitals, and in which the cost of treatment is monitored by a managing company. David, a clinical supervisor of one pad was responsible for the clinical supervision of eight clinical case managers. On typically day, he receives around 40 phone messages about clients that are in need of his services. His job is to field calls from mental health providers seeking authorization to provide treatment for clients. There are those who believe that managed care is simply another example of corporate America discovering a means to increase profits for shareholders of insurance companies, at the expense of individuals seeking mental health treatment. (pg.

Managed care is the provision of health care services being taken on by a single organization in the management of finances, insurance, delivery and payment (Shi, Singh, 2017). Additionally, managed care plans are a type of health insurance that contracts with health care providers and medical organizations, whereas the members are provided care at a reduced cost, usually the lowest possible cost. The amount paid depends on the rules of a specific network.

The growth of managed care in the United States has been paralleled by a rising tide of anti–managed care sentiment. The “managed care problem” is understood generally as the need to protect individuals against large companies that care more about their bottom line than about people. The premise of the BEST (Best Ethical Strategies for Managed Care) project is that the “managed care problem” is best understood as an ethical problem—a conflict of values that arises as the country changes from a patient-centered to a population-centered approach to health care. The BEST project team worked with nine managed care organizations to identify their most intractable problems. The team redefined these problems in terms of ethical dilemmas, and then

Managed care is the most common form of health insurance in the United States, and provides

Health insurance costs are often raised to balance out the potential costs posed by risk factors. This is because insurance companies have to, on average, spend more money to help highly prone individuals. While this practice makes sense financially, it raises some questions ethically. Three risk factors that often lead to companies raising monthly fees are tobacco usage, obese individuals, and people with genetically inherited conditions.

Summers, J. (2014). Principles of healthcare ethics. In E.E. Morrison & B. Furlong (Eds.), Health care ethics (pp. 47-62). Burlington, MA: Jones & Bartlett.

Describe the ethical challenges we face in the future in health services as it relates to health care reform in the United States. We face many ethical issues which include: issues in developing resources, in economic support, in organization of services, in management of health services, in delivery of care, and in assuring quality of care. In developing resources, health personnel, facilities, drugs, equipment, and knowledge are all critical to public health. The types and amount of these are will be crucial to meeting the ethical requirements for public health. Personal autonomy and respect

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 essentially 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 span from less restrictive to more restrictive. As recently 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 the health care systems, such as our hospital’s ability to provide patients

Managed care is a system that puts together the financing and delivery of apposite health care by means of an all-inclusive set of services (Docteur, E., & Oxley, H. 2003).

The term managed care or managed health care is used in the United States to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care.

Managed care Plans are regarded as Health care plans because these plans, are designed to provide care at the lowest possible cost. In order to make coverage affordable, managed care plans assume the risk in exchange for an insurance premium, and it requires that patients follow some rules. The three major types of managed care plans are:

You will hear the term "managed care" quite a lot. It is a way for insurers to help control costs. Managed care influences how much health care you use. Almost all plans have some sort of managed care program to help control costs. For example, if you need to go to the hospital, one form of managed care requires that you receive approval from your insurance company before you are admitted to make sure that the hospitalization is needed. If you go to the hospital without this approval, you may not be covered for the hospital bill.

Managed care has been adopted into the government funded care organizations. Medicare managed care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and the decisions about paying for treatment are controlled by the managed care plan. The basic premise of managed care is that the member/patient agrees to receive care from only a specific doctors and hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care has been used since the mid 1990’s in order to provide healthcare to beneficiaries with serious or life long illnesses. Today, managed care has become a way for states to provide quality care to both Medicaid and Medicare patients.

Health care professionals took an oath to provide each patient with the highest level of quality care at the most utmost ethical level. Providers have an obligation to treat patients with respect, dignity and advance directives. To provide proper care to patient’s providers must order the right test, screening, blood work, and procedure. However, providers must also be cautious not to be unethical by ordering excessive and unnecessary test, which can be a financial burden to patients and their families.