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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...
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…
References:
Boyle, B., Deaton, D. & Maddigan, M. (2010, March 30). United States: The Health Care
Reform Legislation and its Impact on the Health Care and Life Sciences Industries. Retrieved September 24, 2011, from http://www.mondaq.com/unitedstates/article.asp?articleid=97086
Carlson, G. (2009, May 5). Managed Care: Understanding Our Changing Health Care System.
Retrieved September 24, 2011, from http://missourifamilies.org/features/healtharticles/health39.htm
"Managed Care." (n.d.). East Coast Health Insurance. Retrieved September 24, 2011, from http://echealthinsurance.com/managed-care/
The reluctance to refer patients to specialists may also mean that nurses must practice more holistic, rather than specialized forms, of nursing. The desire for cost containment has resulted in many nurses assuming physician's duties, such as those duties confined in previous eras to the patient's primary care physician. In states with high HMO (Health Maintenance Organization) enrollment, more nurses were shifted to lower-paying nonhospital settings, such as in home
• •the marketplace lacks competition. Thus the consumer may have limited choice, and some sellers or manufacturers may not care if the consumer is dissatisfied. (Zelman, 1999, pp. 5-6) Managed care, then becomes an institution that is highly in need of regulation, according to those who make such decisions, as the need to be a consumer advocate (including those who are profiting from health care) has always driven the government to
D.). Accreditation is basically important for various functions such as promoting the quality of healthcare delivered to consumers and other purchasers of care. Secondly, the accreditation is important because it helps health care organizations and facilities to recruit and retain qualified practitioners. This in turn enhances organizational efficiencies to lessen costs, identify means for enhancing service delivery, and lessening liability insurance premiums. Organizations that Accredit Managed Care Organizations in America: There are
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 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 Timeline Luke Medical Center, Pasadena, California - established The change in hospital concentration in 68 large metropolitan statistical areas (MSAs) between 1981 and 1994 is positively correlated with the level of managed care concentration in 1993/1994. Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of patients' ability to pay. 4,908 hospitals in the United States have Emergency Departments. Crowded emergency departments arise because