The Effects of Managed Care on Health Care in the US - Essay Example

Musa Muhammad Bala Academia-Research 7, December 2006 The Effects of Managed Care on Health Care in the U.S. This discussion will begin with an exactmeaning and the definition of “Managed Care”. What is Managed Care? That is the key factor of our subsequent points of view. In one of the articles that explain the above topic, a full and constructive definition is given, a yardstick statement for those who wanted to understand what the “Manage Care” is all about. The definition has this to say: “Managed Care” refers to a variety of techniques for influencing the clinical behavior of health care providers, and/or patients, often by integrating the payment and delivery of health care. The overall aim of Managed Care is to place administration control over cost of quality of or access to health care services in a specific population of covered enrollees”. (Ethics In Medicine). In United States, the health care developing strategies are on the increase, which earn it tremendous impact if overview from the grassroots of this positive aim. The sector has been witnessing a new dimension in recent years, because it’s in no small measure assisted to halt the increase as regarding the costs of health care in the country, given a wider room for the less privileged to enjoy the program, which has been hitherto on the rapid increase beyond their capacities. However, with the introduction of “Managed Care”, some of the employers who guaranteed insurance to most of the U S citizens skipped to adapt to “Managed Care” programmed. Meanwhile, our focus should now assess the whole issue, dated back to early 90s when the Managed-Care system began to have it solid root. The United States Congress has brought a turning point toward enhancing the health care system within U S. “The nation’s health care system stem was under microscope, undergoing a level of scrutiny not seen since the early 1990s, when congress scrapped the Clinton administration’s complex plan to overhaul health care. Since then, employers have acted on their own to control health costs, largely by requiring employees to join managed-care programs, such as health maintenance organizations (HMOs). More than 100 millions Americans are now covered by Managed-Care”. (Public Agenda). The HMOs is one of the key pillars of which the Managed-Care program stands on, while observers concluded that it is almost the best among other related pillars. Another branch of Managed-Care that also need brief explanation is “Capitation”, a system that involves a sort of payment method. This involves paying physicians a specific amount for treatment of patients, not considering how much will be the subsequent cost to be incur. “Some “Managed Care” practices seek to impact the quality care of, for instance, clinical guidelines that aim to alter the clinical management of specific health concerns (e.g., treatment of hypertension) are also common managed-care practice”. (Ethics in Medicine). This is only a nutshell explanation on “Capitation” of managed-care that maintains the expenses of health care. One of the important effects that we ought to bring into consideration while discussing on the Managed-Care on health care in the United States is that most of the citizens were in the view that “Managed-Care has reduce the unnecessary spending, while patients were receiving immediate care with the adaptation of this system, even though in another hand the system (managed-care) bring a new relationship between the patients and the doctors they are assigned to. For example, in some instances in the Unites States, Health Care Maintenance Organizations do not accept to involve patient while contracting with physicians, thus it can turn the relationship between patient and the physicians sour, because mostly they only offer to pay physicians small amount from what they charged from the patients by putting restriction for interactions between the physicians and the patients. As a result, it becomes very hard and uneasy for patients to establish rapport with physicians of their likes. Another angle of this is that, the Health Care Maintenance Organization can cut the relationship existing between a patient and physician unprecedented, and compels to shift to another physician. Additionally, the Managed-Care system has in one way or the other seen with a lot of criticisms, which brings about the advantages and disadvantages of adapting to the system. One of the criticisms the Managed Care undergoing says that some of the Organizations that running the system collide with physicians so they would concentrate less on patients, which at the end they would be compensated, thus they would attend to many patients in a small time paving way for huge incomes to the managed care firms, as the more patients attended, the higher the income generate. Unfortunately, this attitude has drastically reduced the time the physicians given to their patients for proper attention on health problems and finding good treatments. For this reason, patients are putting in a state of risk of their lives as no considerable attention is given to them. Another criticism aspect that Managed-Care service carries entails that some firms do not take their patients to the specialist doctors, only that in order to generate huge money, they conspire with non-specialist medical practitioners, thereby halting patients to look for qualify and minded medical specialist they would give them proper treatments. Some writers also have this to say stressing the points of criticisms: “critics however say managed care firms second-guess doctors, require patients to get the cheapest treatment rather than the best medicine, and try to prevent patients from visiting specialist, who charge more than family doctors. Managed-Care Firms have also been criticized for refusing to pay when a patient goes to the emergency room for something that turns out not to be an emergency”. (Public Agenda). With all these discussions, we come to conclusion that Managed-Care in United States has been given interpretation to various dimensions from concern citizens and expert on health care system. Some are in the view that the HMOs have caused the fallen standard of quality health care, while many others are supporting with their own reasoning and points of considerations. With all these therefore, brings about the motion of advantages and disadvantages of Managed-Care system in the United States. Though a survey conducted has shown that 84 percent of Americans are satisfied with the development: “Yet, most Americans belong to managed-care plans, and a majority say they have haven’t had any problems getting treatment. In one survey, 84 percent said they were or “somewhat satisfied with the health care they’ve received”. (Public Agenda). Despite this commendation by some Americans, there now let make assessments on the pros and cons of Managed-Care as required involving in the essay. This is necessary, because many people in United States when confronted by health Firms to join for managed-care system, but due to lack of proper knowledge of its merit and demerit they ignore the idea. The advantages of Managed-Care system consists of quality care, because ensuring this quality is brought to the front. In this aspect, health care providers and physicians are more knowledgeable of the kind of treatment they are providing and the results of such cares. Second advantage of this system entails that people that reached to old ages who also receives low earnings are opportune to obtain insurance care, and additionally there is less need of paper work. Other advantages of managed-care as grabs from a research state that: “co-payments are pre-determined, thus you always know how much you will be paying out-of-pocket for service. Some limited prescription drug benefits are offered by the plans. However, they usually use a formulary that consists primarily of generic drugs. Cost of Managed Care is usually less than indemnity plans for seniors and for other persons. Some services may be offered which indemnity plans do not offer, such as eye exams, eyeglasses, dental care or other services, and finally older adults sign over their Medicare benefits to the health organizations collects a sum of money each month to provider care to the individual from Medicare. The individual can only see physicians that are approved by the health maintenance organization”. (Managed Care and Patient’s Right). While the disadvantages of Managed Care emerges with a view of research as follow: “Services are limited based upon what the payor agrees to pay. For example, employers will usually outline the number of visits or the amount of money they will pay for certain types of procedures. Medicare beneficiaries are, theoretically entitled to the same benefits that Medicare provider. However, the review for “Medicare necessity is more highly scrutinized and services are usually more limited in Managed Care. Individuals may have to change physicians since all physicians do not participate in all managed care plans and many physicians will only take a limited number of patients with a specific managed care organization. Benefits are usually more limited than in an indemnity plan-number of therapy visits days in the hospital, etc. Some managed care plans are risk contract. The provider (physicians, hospitals, labs etc) shares the risk of caring for individual. Most plans use generic drugs that have a 20% tolerance for bioequivalency to name brand drugs. Specialist care, and sub-speciality care may not participate in managed care plans”. (Managed Care and Patient’s Rights). In conclusion, it is good to note that the managed care in U S can yield more effective outcome if the Government bring some unanimous reforms on the sector, which all Americans will enjoy without much disadvantages. This can be achieved by putting more vigilance on Health Maintenance Organizations, with more strict penalties against any firm that violate the stipulated conditions, by given right to patients to sue their managed care firms, which hitherto that right is not given. Already, in Texas states, patients are given the right to sue HMO’s for any medical malpractice. Work Cited Public Agenda “Health Care Overview” http://www.publicagenda.org/issue/overview.cfm?issue_type=healthcare Ethics in Medicine “Managed Care” Managed Care and Patient’s Rights “Examining the HMO” Read More