Managed care systems and models

Managed Care is an approach or system of health care that manages the use of healthcare services, controls their costs, and evaluates the performance of healthcare providers. It is also considered as an approach to funding and providing healthcare services which focuses on controlling costs and enhancing the quality of care through several methods. Some of these methods that are used in managed care to help accomplish the described objectives include quality assurance, utilization management, and provider network management. Notably, the likelihood of managed care to enhance quality, accessibility, and plans of healthcare services depends on various factors.

In today's health care system, managed care plans exist in various types with the two common types being Health Maintenance Organizations and Preferred Provider Organizations. While most of the other types of managed care plans being hybrids of the two, individuals are required to know the details of their specific managed care plans. Regardless of the type, managed care plans usually guarantee total access to health care for its members on a daily basis (Carlson, 2009). While these plans consist of a primary care physician who coordinates every patient care, the physician makes referral to specialists when necessary.

Origin of Managed Care:

The origin and development of managed care in the United States healthcare system can be traced back to 1973 following the enactment of the Health Maintenance Organization Act. Most of the current techniques of managed care that are widely used by private health benefit programs were initiated and established by health maintenance organizations ("Managed Care," n.d.). The legislation of Health Maintenance Organization Act by Congress in 1973 not only represents the initial form of managed care but it also motivated the rapid growth of health maintenance organizations. This enactment was due to the deliberate efforts to transform the American healthcare system from its conventional non-profit business principles to a profit making model that will be controlled by the insurance industry. The plans were successful since they resulted in restrain of medical cost inflation in 1980s through the lessening of unnecessary hospitalizations. This forced healthcare providers to discount their prices resulting in a more competitive and efficient healthcare industry.

Current State of Managed Care and Potential Impact of Reform Initiatives:

While managed care is everywhere in the United States, it has attracted huge criticism since it has significantly failed in the general objective of controlling medical costs. Consequently, the proponents and opponents of this concept are sharply divided on the overall impact of managed care on the quality of healthcare delivery in America. The omnipresence of managed care in the United States has contributed to the huge percentage of enrollment to managed care health insurance policies by Americans.