Managed care
Managed care and history
Managed care is a system which checks the delivery and controls the financing of health care services among members who have registered in a type of a health care plan.The managed heath care aim is that health care providers provide care of high quality standards to patients in an environment which controls or manages cost. A second goal of managed care is to ensure that the delivered care is appropriate and necessary to the medical condition of patient.
It also ensures that care is provided by the appropriate provides and in the most little restrictive setting. In the United States, managed care is a term which describes a variety of methods or techniques which are meant to improve care quality and at the same time to provide health care benefits which are cost effective. Organizations which ensure the two main aspects are adhered to be called the managed care organizations. The United States National Library of medicine define managed care are a set of programs which are meant to reduce the cost of the most necessary health care (New York Health Plan Association, 2007)
The Health Maintenance Organization Act of 1973 marked the beginning and growth of the United States, managed care. The techniques of managed care were first implemented by health maintenance organizations; however, these techniques are currently used by various health benefit programs. Through a critical analysis called the Social Transformation of American medicine on the issue of Health Care System in America, Paul Starr suggested that it was Richard Nixon who took the initial steps of bringing a change to the health care system of America.
This was a changed which changed the traditional model of not-for-profit business principle to profit model to be taken up by the insurance companies. In the 1980, the medical care plans were credited or minimizing the cost inflation of medical care. Some of the strategies used to achieve this included reducing unnecessary hospitalization, ensuring that the health care industry is competitive and efficient and forcing health care providers to subsidize rates.
The current state of managed care in the U.S. health care system
Currently the techniques of managed care are used by a variety of private health benefit programs after being accredited by the URAC. The accreditation organization deals with the reviewing of each private health benefit program by ensuring that it follows the set rules and laws of conducting its business in a consistent manner with the national standards.
In the US today managed care is a term which has become highly ubiquitous but at the same time become a subject of major debate because of its overall failure to control the cost of medical care as well as the quality of health care delivered in the country.Currently 90 % of all the insured Americans have enrolled in managed care plans. The current techniques in managed care include case management, disease management, utilization management and review, patient education and wellness initiatives. These techniques are used in both benefit programs and net work based benefit programs (Scandlen, 2005).
The potential impact of health care reform initiatives on managed care in the U.S
The reforms in the United States health care system will ultimately change the model of managed care dealing with the limitation on cost. Health care systems which are highly integrated will be at the best position to lead to a more efficient care in terms of value. The managed care system w ill be turned into a medical home physicians and patient advocates who are like the main tools in the new systems focusing on health value and patient advocacy.
This transformation is however virtuous but not a whole metamorphosis process (Ferris, T. G., et al. 2001). The heath care system is focused on developing large providers who are well organized and supported by the commitment to achieve the expected service, quality, and cost in an explicit way through the help of electronic use (New York Health Plan Association, 2007).
Reference
Ferris, T. G., et al. (2001). Leaving Gatekeeping Behind? Effects of Opening Access to Specialists for Adults in a Health Maintenance Organization. New England Journal of Medicine 345 (18), 1312-1317. Retrieved from http://content.nejm.org/cgi/content/full/345/18/1312.
On March 28, 2011
Scandlen, G. (2005). Consumer-driven health care: Just a tweak or a revolution? Health Affairs 24(6), 1554. Website Resources NCQA (2007). Managed care Organizations, Accreditation MCO. Retrieved from
http://web.ncqa.org/tabid/67/Default.aspx.
On March 28, 2011
New York Health Plan Association (n.d.). Managed Care vs. FFS Chart. Retrieved from http://www.nyhpa.org/AboutHMOsinNY/ManagedCareVs.FFSChart.asp. URAC (2007). General Questions about URAC Accreditation. Retrieved from http://www.urac.org/accreditation/.
On March 28, 2011
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