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Managed Care Services in the USA
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Managed care is a definition that refers to many techniques or working models that are intended to minimize the people’s expenses for the providing health care benefits. Also it is used to improve the quality of services. These systems may include aspects of financing and delivery of health care to enrolled organization and economic incentives. Additionally they include the cost sharing options and controlled length of hospital admissions. In the USA these programs are provided in many settings.
The overall growth and management of such models were triggered by the enactment of the Health Management Organization Act of 1973. Currently these programs are used also by a variety of private investors though traditionally they were pioneered by the health maintenance organizations. Unfortunately, over the time they have failed to achieve the intended objective of lowering health care cost. The general impact of such programs on the quality of health service delivery is still a contested debate.
These plans were greatly credited with subduing medical and healthcare cost inflation in the late 1980s. They became very effective in minimizing the unneeded hospitalization; as a result, they compelled providers to embrace more competitive approaches to service delivery and efficiency. Unfortunately, since the premise of the programs was to operate on not for profit basis, it eventually created a consumer backlash. The element of a cost-control involved the initiated reaction and general perception or misconception. The operators in this program were more oriented on the saving dollars as opposed to the provision of the quality health care.
From this point of view, the Kaiser Family Foundation conducted a survey in 2004 and got the interesting findings. One of the key results of the survey was that consumers perceived that managed care decreased the time that doctors could spend with patients. Apart from that most respondents believed that these programs hinder the best opportunities for patients to see specialists and equally failed to hav significant improvements on health care in general.
Patients, critics and advocacy groups agitated against the element of controlled cost in these programs. Their arguments held that cost control translated into the denial of medically necessary services sometimes even in life threatening situations and this triggered low quality service provision. The public lobbying instigated most federal states to create a new legislation that mandated the managed care standards specifications. On the other hand, insurers responded by floating alternative care plans and comprehensive care networks.
Experts claim that by the late 1990s, the US per capita health care spending began to rise again reaching some peak in 2002. Despite of the mandate for the managed care to control cost, it is observed that US healthcare expenditure is on the rise even outstripping the overall national income marginal increment. It is estimated to reach a 2.4 percentage faster than the annual GDP since 1970.
According to the estimations of the Americas Health Insurance Plans, 90 percent of insured citizens are equally enrolled in some form of the managed care. However, there are many providers of the managed care which are geared towards profits hence exposing the American families to increasing their health care costs. Critics cite the profit motive to be working negatively from the traditional premise of the programs.
In these unfolding scenarios, families will have to contend with higher health care costs. It should be taking into account the challenges in economic depression recovery, increasing unemployment rates and rising of the living costs in general. It is quite unlikely that the American family or individuals with the average low and middle income will have an adequate financial capability. It will be impossible for them to enrol or continue to sustain the remittance of health care insurance premiums. It will cause the increased number of the uninsured individuals.
Wheen someone is uninsured, the financial strain of meeting medical bills is completely far out of pocket and beyond the reach of many. In this way the families are exposed to the dangerous and risky conditions of an inability to meet the medical cost; it may mean a matter of life and death for many. Uninsured low income households or individuals will be hanging their health and lives on the balance. On the other hand, decrease in the number of uninsured people will eventually drive away investors of these programs. Thus, it will deteriorate the whole situation and spread more pressure and further price hikes on the managed care.
The overall effect will be decreasing the quality of the health care provision which again will result into the lowering of the quality of life of the American people. All the same the government needs to look into the legislation that can help to improve a quality of the medical care and managed services. At the same time it should make the legislation affordable to the average citizen. Law makers can target to improve the managed care techniques or models by creating more incentive brackets or subsidies.
Encouraging use of the integrated delivery systems is one of the possible solutions. The enrolled individuals can be attended to by a network of service providers as one of the ways to moderate and keep cost at the reasonable levels. This integration may include a set of doctors or health care centres operating as a network. They can have an agreement to offer a range of services to the beneficiaries in the plans. The plan can extend further to include the financial incentives awarded to enrolled individuals as an encouragement for using the care efficient alternatives.
Exposing the American families to the rising cost of the managed care will in turn expose citizens to life threatening risks. Most people will be unable to access the quality health care. When the majority of citizens are at the low or middle income levels, the multiplier effect of failed health insurance provision can create a huge burden on the state. Thus, the affordable manage care is essential.
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