BHS450 Managed Care..Case...Mod 3

MANAGED HEALTH CARE Student Name: Student ID: Course Title: Course Code: Course Instructor: Section: Institution: Date: Introduction In the United States, the term managed health care or managed care is applied to express an array of different concepts and techniques aimed at reducing the cost of providing health services as well as improving the service quality. Various health organizations and service providers use these techniques. Sometimes they even offer the techniques to other organizations which are often called Managed Care Organization (MCO). The United States National Library of Medicine defined managed health care program as an initiative or program of reducing unnecessary costs in the health care system by using assortment of mechanisms which include economic inducements and motivations for the patients and physicians to choose less expensive forms of health care, different programs and techniques for reviewing and improving the medical requirements in specific services, sharing amplified beneficiary rates, controls and monitoring the admissions of the patients and lengths of their staying in the hospitals, the issues of cost sharing as well as reasons for outpatient surgery. The health care programs and strategies may be provided in different settings within different systems, like Preferred Provider Organizations and Health Maintenance Organizations. The very first attempt of the managed care system was initiated with the Health Maintenance Organization Act of 1973 which introduced the growth of Health Maintenance Organization (HMO). However, it was not until the late 1980s when the managed care system became popular and started to be credited widely. The organizations used managed care introduced several cost effective steps, like reducing needless hospitalizations and forcing the organizations that provide health care services to increase discount. This made the health care industry more competitive and efficient. The managed care concepts, plans and strategies became very popular in United States. However, there were several contradictory issues. As most of the managed care health service providers were profit based companies, they were accused with the perception that these companies were more concerned and keen in saving money rather than offering quality health care. There have been many critics of the issue, including consumer advocacy groups and dissatisfied patients, who pointed out that managed health care strategies were putting restrictions on medical costs by avoiding medically essential services for the patients. The seriousness of the allegations led to pass laws, mandating standard for managed care plans. The rate of health care spending started to increase around late 1990s. Managed Health Care System in America In the United States, the introduction and development of managed care was encouraged with the Health Maintenance Organization Act of 1973. Previously, most of the techniques and concepts of managed health care were owned by different health maintenance organizations. However, in recent years, they have been used and operated by various private health benefit programs. Currently, the managed care is almost an omnipresent issue in America. However, there have been many controversies and arguments regarding managed care among civilians, critics and proponents. The main issue is the system has not been successful enough to reduce or control medical costs as it promised in its core concepts. In current health care system, the managed care plans are mostly offered by health care providers that maintain integrated network system to offer efficient services to enrollees, selecting cost effective service providers and reduce cost by consulting affordable fees (Managed Care: Integrating the Delivery and Financing of Health Care - Part A, 1995). Sometimes, financial initiatives are used to encourage the enrollees (Lynch, 1992). Services under these providers cost much less for the patients and according to the America’s Health Insurance Plans, out of network service provider charges extremely high fees from the patients (Kolata, 2009). Managed care service includes disease ma...