Analysis Of Managed Care

1489 words - 6 pages

An Analysis of Managed Care

Medical costs progressively consume a large part of the Gross Domestic Product of the United States. Various sectors that seek health services including the government are increasingly turning to a regulated form of financing and delivery of health services termed as managed care. All citizen in the United States is eligible for this form of care whose purpose is to make medical care accessible for all. This paper seeks to provide a thorough analysis of managed care detailing its role in the transformation of health services, its impact on various heath aspects including access, delivery of care and ...view middle of the document...

Premiums for this type of care are higher than those of a Health Maintenance Organization. On the other hand, Point of Service Providers acts as mitigation agent for Health Maintenance Organizations and Preferred Provider Organizations. They usually require members to have primary care physicians and include extra fees for seeking health care outside the network. The point of Service premiums is usually higher than those of Preferred Provider Organizations (Shortell, Gillies, and Anderson, 1994).
Managed care organizations slightly defer in their version of managed care; they are embodied in three similar doctrines. The first is that managed care is a moderately refunded medical care delivery system with clearly stipulated premium and covered benefits. Secondly, stakeholders of the system are financially and contractually allied to each participant share in the financial risk. Thirdly, managed care regulates the expenditures by controlling the demand and supply of resources in health care (Shortell, Gillies, and Anderson, 1994).
Delivery techniques of consultative care have been key in the facilitation of medical services in an outpatient setting of care as a result of its focus on prevention rather than cure. Inpatient admission is attributed to medical cases that are dire and are in need of thorough observation by medical professionals. The delivery of managed care has also altered the delivery of care as a result of the merging of primary care and public health that encourages the utilization of a medical home model as a form of care in the process reducing the number of patients that require the use of hospital facilities such as beds. Reduced costs of health care also allow patients to seek care prior to ages that have a high susceptibility to ailments for instance aged patients (Shortell, Gillies, and Anderson, 1994).
Impact of Managed Care
Managed care has tremendous effects on the provision of health care in America. The ethical importance of this form of health care is to provide medical services irrespective of its costs to patients. One of the most significant impacts of managed care is that it restricts provider network. Managed care organizations often seek to bring together entities that are sufficient enough in terms of their heath provision capabilities. However, problems arise in achieving better health quality when small entities limit the choice of available heath care programs. The notion often disrupts family physician relationships since it also restricts physicians from seeing a physician of their choice (Folland, Goodman, and Stano, 2007).
For instance, youngsters with special needs may have limited access to pediatric doctors who have experience in treating of critical child conditions since they are trying to control health care costs. It is observed that the probability of visiting a pediatrician of one’s choice is lower as opposed to as opposed to fee for service plans in healthcare. The notion leads to...

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