Managed Care
One issue that has received a great deal of attention in recent months during the healthcare debate is the role of health insurance companies. Managed care was originally intended to lower costs within the American healthcare system to prevent overconsumption of health services that were unnecessary or of unproven value. However, the overall costs of the American healthcare system have increased rather than decreased in recent years, despite the rise of HMOs (health management organizations), as have the numbers of uninsured Americans unable to afford to buy health insurance. Many of these persons use the emergency room as their primary site of healthcare.
There is clear evidence that some Americans with high-quality health insurance are over-tested, despite the existence of HMOs. "Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone" (Gann 2012). However,...
"California HMOs reject one out of five medical claims" (Girion 2009).
The Affordable Care Act (ACA) was designed in part to counteract some of the abuses perpetrated by health insurance companies, such as denying patients with preexisting conditions. With the ACA, however, because there will be more individuals with health insurance in the 'risk pool,' theoretically there will be less financial pressure to reject offering insurance to the uninsured. The system will become more cost effective if more patients can afford preventative medicine and stay out of emergency rooms, except when a genuine emergency arises. The benefits of the bill remain to be seen. But here is nothing more heartbreaking than to see a patient make medical decisions for financial reasons, versus for reasons directly related to his or her health. Every nurse has had the experience of seeing a patient receive a recommendation for a particular kind of treatment, only to have the patient decide against it because the patient's insurance company decided that it was not cost-effective. Some patients even shy away from seeking basic, preventative care that could save the system money in the long run because of high copays or a lack of insurance.
Film review: Sicko
Michael Moore's documentary Sicko is…
Managed Care Organzations. (MCO) Since the increasing costs of health care insurance became a significant issue in the profitability of health care provider in the 1980's health care provider, insurance companies, doctors and hospitals have searched for creative ways to cut costs while not sacrificing care qualitative. What has evolved in the health care industry is a shopping list of various organizations which offer health care services. The different organizations all
Managed Care Plans Analyze how the policies and practices related to Managed Care Plans can influence the activities of managers in health services organizations. Over the last several years, the role of health care organizations has been continually evolving. Part of the reason for this, is because costs have been rising exponentially. Evidence of this can be seen with a survey that was conducted by the Kaiser Foundation. They determined that over
managed care in modern health care. Specifically it will include a brief history of managed care, along with some pros and cons about the process. Managed care is an arrangement where an insuring organization accepts the risk for providing a defined set of health services, using a defined set of providers, for a defined population, in return for a fixed or regular per capita payment" (Lammers and Geist, 1997, p.
, income is quite often decreased and patient care sometimes adversely impacted due to time constraints, the need to hire a dedicated insurance person for the office, and the innumerable and sometimes counter-productive, forms and questions the HMOs ask of their medical professionals (See: Zimet, 1989, 2002). The survey instruments were both quantitative and qualitative in nature, and included four to six sections: basic demographics; general information about the practice (theoretical
care I receive is delivered in a managed care style. The options of going to different care providers are limited so as to keep costs low, and my insurance company takes care of giving me a list of options. The doctors are designated along with the healthcare facilities -- and this goes to make up the provider network. Much of the care that I receive also focuses on preventive medicine,
Nursing Tasks, Methods, And Expectations State of the Industry The Art and Science of Nursing Relative Pay Scales Male Nursing Roles Sex Stereotypes The Influence of the Nationalized Healthcare Debate Proposed Methods toward Recruiting Nurses Joint Corporate Campaigns Steps to Recruiting Men Wages issues Recent employment trends in the nursing field have demonstrated a disconcerting drop in the number of employed and employable nurses. In what has been traditionally a female dominated filed, the exit rate of both men and women,