Custom «Managed Care» Essay Paper Sample
Managed care refers to a method of healthcare that strives to restructure health services, as well as ensuring cost-effective healthcare. This kind of care aims at ensuring a definite benchmark of care, extent of performance, and cost management. It guarantees this by ensuring a thorough supervision, monitoring, as well as counseling. Moreover, certain sorts of managed care programs aim to support members to live healthy by preventing diseases. Ideally, managed care covers partly or all costs accruing from healthcare services. Such programs normally have members who they advice to seek care from accredited providers (Lundy & Janes, 2009). However, some normally allow their members to seek services from other providers other than the registered. Consequently, provides outside the network wrap fewer costs. It is certain that managed care has faced some hiccups along the way; however, chief players have managed to counter such shortcomings for it to remain the preferred health care option for the majority.
Managed health care traces its roots to 19th centaury when DR. Shadid Michael commenced a countryside farmer's supportive health program in Oklahoma in 1929. He managed to catalog more than a few families who paid a predetermined charge to acquire services, despite strong antagonism from other physicians. In addition, in 1933 other doctors launched the provision of medical services for over 5,000 employees on a prepaid ground. Such providers obtained recompense from insurance corporations to cater for accidents since men were donating 5 cents from their earnings. Henry Kaiser later set some medical plans throughout World War II, but stepped up his services to cater for millions of Americans at affordable cost (Lundy & Janes, 2009). Ten years later, the Kaiser's health plan had a mounting complex of hospitals and clinics. Numerous prepaid cluster practice plans extended in the 1940s, which later turn nto precursors to the contemporary Health Management Organizations (HMO). However, these groups varied in their corporate organizations. It is noted that the managed care faced resistance from structured medicine, as well as the American Medical Association (AMA). The AMA was contrasting any form of non-physician authority over medical experts since it viewed it as disreputable. AMA tried to stifle the development of prepaid schemes and co-operations. The Supreme Court rebuffed the AMA claims in 1947 that medicine was a career but not a business. The AMA thrived in their struggle, which Okayed people to select their healthcare givers, and this move picked in 1950s. Politician Richard Nixon altered the American health care scheme from the non-profit to revenue generating organizations, thus allowing the insurance business to manage them. The congress conceded the HMO Act in 19733 thus fueling the expansion of HMOs. This act permitted $375 million in central account to expand HMOs. The government devoted to sign up 90% of the populace by 1980. Even though the goals have not been met, managed care is continually growing (Lundy & Janes 2009).
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Managed care has been overriding in several states in the past 15 years. At least 70 million Americans have registered in the HMOs whereas 90% have been a fraction of the Preferred Provider Organizations (PPO). Although there has been a turn down in joining managed care, it remains the ideal kind of health care and cover up. The need to advance result and efficiency in health care inspired the progress of managed care in the US. Currently, research shows that managed care has managed to diminish healthcare costs amid the US citizens through constricts on exploitation of services. In the western parts of the country, managed care has managed to lessen the hospital admittance rates, as well as time-span of stay. It is imperative to assert that there is an upward dissatisfaction with maanaged care organizations, and numerous people suppose that the system will not persist with its present state. Changes are impending since there is a taut competition amongst managed care themselves. It is thus believed that charges and benefits will no longer be the driving force, but value of the health care will take preference (Shi & Singh, 2008). The novel scheme of the managed care is determined to purge all the intermediaries so that health care providers can deliver their services straight to the employers. This is imperative since owners would reimburse less, on the other side, providers would obtain better reimbursement. Accordingly, clients would obtain enhanced services.
The health care reforms, especially HITECH Act, have some considerable impacts on the managed care. It is noted that the new reforms will consequence into emergent of dozens of fresh organizations and grant programs. Government assistance, intercessions, and guidelines are having augmented impacts on the payer's actions, charges, and marketplace stratagems. All these normally have negative impact on the managed care. The reforms that vouch for transparency to health program data and operations have forced the managed care to be more complying than before. However, this has led to first-rate service to the citizens. Programmed Member Acquisition and Retention is a reform, which has great impact on managed care (Sultz & Young, 2010).
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Managed care has undergone evolutions since 19th century to become the preferred health care service. It has been branded one of the efficient, as well as effectual health care in the US and far. Currently, this method of service is currently reducing the health care cost through reduction of hospital admission. There has been a great interrelationship between the managed care and the health care reforms. The health care reforms have presented some potential impacts on managed care.
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