Significamt Health Care Event Essay

Health care cost has risen dramatically in the last decade. Health care plans have been forced to look at the quality of health care given by the providers so they can implement certain strategies to help reduce heath care costs. Managed Care describes a group of strategies that is looking to reducing the costs of health care for health insurance companies. (Kongstvedt 2007)

One of the trends now in Managed Care is the significant increase of federal spending for Medicaid Managed Care. According to

While examining the 1787 Constitution, specifically in article 1, I noticed a few clauses that I found particularly interesting. Section 3, clause 2, informed me that senators are split into different classes with altered election periods. For example, one-third of the Senate contains first class senators who are open to election every 2 years while second class expires every 4 and third class every 6. Which allows the senate to be a continuous body. Also in section 8, clause 7, states that congress has the power “establish Post Offices and post Roads”. Personally I’ve always assumed that roads and post offices were determined by the states but now that I’m thinking about it, I can see where leaving this responsibility to the states may cause

emerge as a professional entity until the beginning of the 20th century, with the progress in biomedical science. Since then, the

In this country there are numerous concerns about health care economics. Several factors contribute to the increase of health care costs. One area of concern is the impact of managed care on health care finances. Managed care has been around since the early 1970s. The definition of managed care is a set of contractual and management methods implemented to manage the financing and delivery of health care services. Initial implementation of managed care was for health care cost saving (Getzen & Moore, 2007, p. 203, para. 1). Though Managed care initially addressed several health care finance issues, there are still problems with the current

Managed care and its competition is being viewed to solve their issue on the struggle to control

Health insurance has a long and extensive history in the United States. The history or beginning of health insurance can be traced back to the Great Depression in the 1930s. The Depression affected several indigenous hospitals in the United States. In order to ensure adequate payment for medical services during the Great Depression, hospitals and physicians had to establish and implement different types of insurance. The health insurance was also meant to cover different types of injuries and sicknesses at work environments. In the same period (Great Depression), managed care and conventional insurance were also brought into existence. Managed care was later developed in the 1980s.

"Compared to Medicare fee-for-service, managed care plans typically cover more services and impose lower out-of-pocket costs but is limited to the providers authorized by their plan" (Scanlon, 1998). The question of quality of care and services provided started to chink away at the armor of managed care.

In an attempt to understand the impact of managed care in the U.S, I look at the most commonly expressed complaints against the organization. In a survey of consumers, 60% said that managed care had not made a difference in health care cost or had actually been the cause of the increase of health care cost. Managed care has had an impact on slowing the rates of growth in the costs of two major health care producers: hospitals and physicians. Little evidence has suggested that the current reimbursement are inadequate to the care provided. The quality of care is a highly debated issue. Physicians are concerned that the quality of care in managed care organizations may reflect the loss of professional autonomy through pre-authorization procedures.

The expanded health insurance coverage via the Affordable Care act is having a major effect on managed care hospitals in many avenues. These effects are impacted via the increase in demand for care, the increase of patient revenues, as well as a lower uncompensated care especially for the uninsured. Not surprisingly, the constraints as well as the controls that are being imposed by the managed care have lead to an outrage by the doctors and their patients. Managed care in the United States finds itself under attack from every side. As far as the managed care organizations are concerned, administrators are unease regarding the profitability or the surplus for reinvestment and even the consumers are also worried about the possible closure of hospitals (Goodson, 2010). Managed Care Organizations have been forced to reduce hospital utilization even though there have also been a few facility closures.

Managed 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

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

The healthcare climate in the United States was grim. Per capita spending was amongst the highest in the world, and while more than four out of every five Americans had health insurance of some kind, spending on healthcare continued to increase and services continued to decline. Insurance companies had the ability to deny coverage when people became ill, and they limited their responsibility towards those who were insured by enforcing both annual and lifetime limits. Those who had pre-existing conditions had great difficulty getting insurance. Profit margins for insurance companies became steeper, but the health of Americans suffered.

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

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.