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The Basics of Managed Care - Essay Example

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In a nutshell, managed care implies the techniques employed to reduce the cost of providing health care. The writer of the following essay would investigate the aspects of managed care, and, moreover, investigate its impacts on health maintenance organizations…
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The Basics of Managed Care
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Download file to see previous pages Managed care is elusive of clear definitions. This can be attributed to the fact that it refers to both programs and cares handled by organizations. The programs look into the coordination, rationalization and delivery channels of care. These channels ensure that the programs avoid risks at all costs. Organizations involved in managed care assume the responsibility of all financial risks involved. According to ‘‘The Basics of Managed Care’’ managed care system dates back to 1973 when politicians took practical steps towards changing American health care program. The transformation revolutionized health care into a profit-making venture for the insurance industry. Health costs soared to the roof. Service providers made large sums of money as consumers shied away from Health costs. Strategies were adopted aimed at modifying both the consumer and the providers’ behavior. Consumer-focused strategies took the form of co-insurance levying. Provider-based strategies aimed at changing the mode of payment at hospitals. Insurance companies altered the modes of payment. Managed care is different from conventional health insurance in that the managed care organizations can either directly provide services or provide the services through contractual agreements. In conventional health insurance, the insurers are not involved in the delivery system. When one mentions managed care, health maintenance organizations automatically come to mind. After the enactment of the Health Maintenance Organization act of 1973, HMOs grew in large numbers (Patel & Rushefsky, 2006). This is partly because the legislation promised to give financial support to HMOs that met the federal certification criteria and offered good packages. Participants in managed care There are various models of managed care organizations. Staff model HMO was the original managed care model (‘‘The Basics of Managed Care’’). This model included physicians as salaried employees or HMO partners. They were entitled to bonuses, incentive payments, and profits. This model employed physicians from common specialties. It was also referred to as closed panel HMO. This was because it was not open to community physicians. These HMOs may own hospitals but most prefer to have contractual agreements with hospitals. The second model is referred to as the group model HMO. This category includes a multi-specialty physician group. With such an arrangement, ‘‘The Basics of Managed Care’’ notes that HMO members have access to all physician services. Another variant within the group model involves physician group sponsors. Group model is also known as closed panel HMO. The group model also has a network model variant. In such a model, the HMO enters a contractual agreement with many group practices to provide medical care. On other occasions, they enter contractual agreements with multi-specialty clinics. These HMOs are either open-panel or closed-panel. The network-model HMO; is the third model where HMO contracts have more than one group practice providing physician care to members. At times, HMO contract big specialty clinics while in other times they work with smaller groups of primary care physicians. ...Download file to see next pagesRead More
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