Future of Managed Care

Future of Managed Care

Medical facilities have become much more important today than they were ever before. The complex diseases are treated by treatment methodologies and the equipment that were nonexistent a few decades ago. But these facilities have also increased in the cost of treatment. The medical facilities thus need to find ways in which a patient can be offered services without over-burdening him. The financial and economic situation of the country as well as the planet has pushed many people below the line of poverty but the health conditions of the population have generally decreased. Thus there is a need of incorporating procedures that do not compromise the quality of health care services while reducing the costs. This can be achieved if the triangular elements i.e. state, hospitals and the patients collaborate and understand the limitations of each other without exploiting the needs of others. The doctors should avoid the costs of irrelevant tests and the hospitals should not over crowd the facility because it will increase the cost of operations and will charge the patient more for the service. The state bodies are recommended to work in collaboration with the private bodies to ensure that the quality of service does not vary for rich and the poor. The employer-sponsored insurance should not be the only choice for citizens. Even when the people cross a certain age, they should be helped thorough Medicaid programs. It is concluded that the problem of ensuring managed care is possible only through a collaborative mechanism between different sectors of life and public and private efficiency.

Introduction

Health is the basic element that a society seeks just like well-being, education, justice and fairness. With the development of technology, it has become possible to treat a disease through state of the art machines and methodologies that are simply classy and seem out of the world. However, the treatment and medical care facilities have become so expensive that not everyone can afford them. The poor can hardly afford the pills and they cannot imagine spending huge amounts on the relevant and irrelevant medical tests (Mehrotra, Croft, Day, Perencevich, Pineles, Harris, Weingart, and Morgan, 2013). Thus, the approach of managed care aims to search ways and techniques through which the costs of providing health care can be reduced to an extent that it becomes affordable for the general public too. This concept also aims to improve the quality of health care while the financing methodologies for providing medical care are parallel improved. The hospitals, medical institutions and state bodies sort out economical methods and incentives for both the patient and physician to encourage the supply of managed medical care. This paper studies how medical care can be managed to reduce cost and improve quality of service.

Thesis Statement

How medical care can be managed to reduce cost and improve quality of service?

Patient care preferences

The medical care facilities in hospitals are designed keeping in mind different social classes of life. Most public health care facilities are designed for all the citizens and not only the rich or economically settled class. All the patients are considered equal and offered same quality of service. Now, since all the social classes visit these medical centers, the administration seeks to enhance the quality as well as reduce the costs. The physicians have to understand that each patient is a unique case provided his background, symptoms and lifestyle. Not every patient can have same causes for fever thus he should be handled with specialized care. Also, there are patients that are interested to conduct medical tests just for the sake of satisfaction and insurance that they do not have a disease. On the other hand, the poor population is not able to spend extra amount on irrelevant tests. It is the job of the physician to take detailed history of each patient so that he is not mixed with other patients while prescribing medical tests and procedures. Keirns and Goold (2009) suggest that there are two medical approaches that are evidence-based medicine patient-centered care. While the first approach believes in trial method and believes only in what the test-results show, the patient centered care on the other hand believes in offering medical service that satisfies the patient above all and does not put him in extra disturbance. Such disturbances might include extra expenses, medical errors and low quality service. It is taught to the medical professionals as a professional value that they should treat the patent with care, respect and compassion since medicine is a full dedication (Cornwell, Goodrich, 2009).

Offering Right Care

When a person gets diseases, he can only think, pray and make efforts to get rid of it. Rich as well as poor alike, depending on their capacities, wish to do anything to get well again. While there is no single universally right pill for all diseases, everyone gets separate treatment given some time and money limitations. A treatment cannot be right if it is not offered in time even if it is the most expensive medical service. Thus the time and environment of the medical treatment is very important (Aiken, Clarke, Sloane, Lake, and Cheney, 2008). For those medical professionals that want their medicine to work on the patient, they should ensure that the schedule of medical doses is followed and the patient is regularly visited.

The doctor may suggest that one capsule, a pill and an injection for a particular patient to get well from a seasonal disease but this will happen only if the nurse and patient follow the right care pattern. If a dose is missed, injections are delayed and meal is not taken properly, the medical staff and the patient should realize that the disease can become prolonged and not remains just a seasonal fever or allergy but can become more problematic. Such situations also make the medical treatment more complex and expensive. Thus to ensure managed care is offered a medical facility, the staff should understand their responsibility with respect to following treatment schedules of all the patients.

Avoiding Unnecessary Procedures

Medical treatment is not simply a word of magic. It is not something said and done in no time. The doctors take time to understand the patient conditions on the basis of it; they prescribe some medicine or ask for further tests to be confirmed about nature of disease before starting the treatment. The medical tests take time because the blood and other cultures need time to develop and show results. Hence, the physician must not order tests unless he is sure that such test are relevant. The two reasons for doing so are the elements of managed care that is cost and time of the medical treatment. The irrelevant tests add to the costs of the overall procedure. A single test can be as expensive as all the other procedures and medicine. The team of nurses and physicians should confirm that the medical test best fits the symptom of a person. Also the single test takes from several hours to several days. So, ordering an irrelevant test would mean wasting time and risking the life of patient in critical condition. It therefore becomes a question mark on the managed care.

There are many ways in which a doctor and his team can be confident that money and time is not wasted in conducting unnecessary procedures. The physician and his team can run a joint investigation on the patient. This would involve taking patient history and finding his symptoms. Thus, it becomes simpler to diagnose a disease if it is found in the family history rather than conducting all the tests to ensure it. Once the disease is found in the family history, the test list can be narrowed down. Also the physician show favors the patient rather than favoring the hospital administration because conducting more tests favor the revenues of a hospital.

Contract Agreement

For centuries, the medical profession was taken as most humanitarian but somehow it turned into a money making industry lately. The hospitals and pharmaceutical companies not only device treatments for diseases but also get patents for the rights of a technology, thus limiting others not to use it for years so that the inventing company can make money independently for some time. Also it is a practice in medical industry that physicians decide the minimum fee for a treatment so that there is an industry rate below which the treatment cannot be offered. It is ethically important and required that the financial position of each patient should be understood. The doctors and health care practitioners should have be allowed to enter a contract agreement but should make sure that no poor patient should be left from getting treatment if he cannot afford the treatment. Also, the contract agreement must be under check and balance of state bodies so that an unfair price is not set for treatment. There are often very unfair fee rates set for donation agreements. Thus the cost of an organ is often less than the transplantation cost. The agreements either for test fee, trail fee or donation must be set with a patient centered philosophy in mind (Model Agreements, 2013).

Cost of Health Care

A patient should not expect the hospital to simply charge him for the medicine and tests he avails for his disease. It should be noted that there are multiple cost factors working in a hospital simultaneously. The training and education of doctors, surgeons and nurses is a big expense on individuals and the hospitals. Thus, the fee charged to the patient is based on the hospital's expense on hiring medical talent, staff, technology, equipment, building and running and operating medical facility (Epstein and Street, 2011). It would be unfair to demand medical care from a facility excluding all these expenses because managed care believes in lowering costs but also paying for the quality of service.

The costs of building and the cost of equipment in a medical facility can be reduced using many ways. If a land is very expensive in a populated or commercial area, the administration may decide to purchase land for the hospital in an area near by city and purchase medical equipment from an auction. While it seems a simple solution, there are many complexities involved. The distance from a populated area may add up to the traveling expense that the patient has to pay. Thus the cost of care will yet be increased even after avoiding the cost of an expensive land. On the other hand, the medical equipment that is purchased form auction may be outdated or faulty. Therefore it is a risky venture to purchase second hand equipment to reduce costs and expenses. The medical facility should thus make very detailed analysis before investing in equipment and building as well as the medical talent that the cost of the acquisition should be fair and justified by the performance of the asset. The patient in regard should also consider that there is a quality expectation from managed care and it is also hoped to be cost effective yet there are some costs that cannot be avoided since they ensure our convenience.

The hospital budgets are often limited by hospital revenues and the funds it receives from charity or federal programs. These budgets should be managed in a way to ensure highest productivity. The hospital administration should take keen interest in hiring optimum number of medical and non-medical staff. There should neither be lack of medical staff nor will overcrowding because in that case too many professionals be an additional cost for the hospital. The right numbers of professionals in a facility ensure that jobs are clearly communicated as well as understood achieving quality of medical services.

Enrolling Patients

In a medical facility, often patients are treated differently base on the nature and intensity of disease and the urgency of treatment. There are many types of categories of medical treatment and two of them are Medicare and Medicaid. Both the Medicaid and Medicare are medical procedures that are state sponsored and help cover the costs of conducting a medical business. In the simplest definition, the two can be differentiated as the Medicare covers the medical treatment that is long-term while the Medicaid, as it is understood from the name Aid, offers help in managing medical costs to the poor patients. However, there are much more details and cost concerns and nature of treatment that is included in it. There are many benefits for the public in the two procedures yet the frauds in the two cost multibillion dollar lost each year (Matthews, 2012). The Medicare primarily deals in Social Security and it covers the aged population of United States where all the citizens above the age of 65 years having some disabilities are paid insurance and other services not based on their income. They are helped to pay their medical expenditures to support their health. On the other hand, Medicaid does not consider the age of people rather offers services to all those counted as poor according to American standards. The Medicare is offered beyond a certain age to all while Medicaid is offered only to the poor. Both the services may include the expenses of Hospitalization, lab testing, family planning, x-ray, nursing, doctor expenses, clinic treatment, surgery expenses etc.

The different systems work for enrolling patients in each of these categories. One patient may fall in both the categories but it would double the burden on the state and medical institutions if the patient receives services from both of these facilities (Berry and Dunham, 2013). There can be an integrated system in which it can be ensured that a person can receive finances either under age group category or financial status basis because there are so many patients that need to be served and managed care demands to minimize the costs and eliminate frauds.

Role of Government Regulations

The size of American population is big enough for the public facilities to offer medical services alone. There are many private organizations serving patients too. However, the state has the duty to ensure that these facilities do not overcharge the patients and that the patient is served with quality as well as minimum costs. In this regard, the state makes policies to ensure reduced cost. There are state bodies like ERISA and HIPAA that make health care policies.

HIPPA is the Health Insurance Portability and Accountability Act that makes policies to help people avail health insurance services at individual level once they have lost their group insurance. The individuals may often still satisfy the group insurance condition but lose the insurance and such people are not ignored rather offered managed care. HIPPA ensures that such people if they had previous 18-month insurance can have new one. If a patient earlier had employer-sponsored plan, it can be renewed for him without the employer. The HIPPA requires such citizens to fulfill certain federal requirement and then benefit from state sponsored Medicare (HIPAA and Conversion Coverage, 2013).