Health Insurance and Managed Care - Assignment Example

Outline Introduction Cost Costly but Superior No out-of-pocket Payments Access Increase Healthcare Access Choice of Physicians Bureaucracies hindering Access in Health Insurance Quality Preventative Confidentiality Construed Objectives Conclusion Health Insurance vs. Managed Care Introduction Managed care is an arrangement meant to meet the healthcare needs of a certain group or groups of people. These include workers, rural residents, and family in the mining, lumber and railroad businesses. In these groups, those that enroll pay a set fee to physicians who in turn provide medical services under certain terms. Insurance, on the other hand, is a plan aimed at paying premiums to a company that in turn remits the funds to the health care provider of one’s choice. However, health insurance, as opposed to the option of managed care, is business focused rather than a healthcare service provider. Rates / Cost The goal of this medical plan is to reorganize medical care to provide millions of people with prepaid and comprehensive services at prices they can afford. The rates are low making it affordable, and at the same time, they do not compromise on the quality. It is this same managed healthcare plan that receives discounts for its members (Kongstvedt 97). Despite having higher premium rates as compared to health insurance, the managed care subscribers tend to have superior coverage and benefits as well as having utmost emphasis on preventive care, outpatient care and other services not included in insurance covers like immunizations, as opposed to those who have health insurance. At the same time, managed healthcare pays the health care providers directly, so that the enrollees do not have to pay out-of-pocket for covered services or submit claim forms for care received from the plan's network of doctors. This is as opposed to health insurance where one has to pay premiums that are usually expensive (Brisenbaum p2) and the medical care provided is not proportional. The people enrolled in the health insurance program are over insured meaning that the premiums they pay for include uncertain expenses. Furthermore, under the expense is the part where the medical care providers raise their fees especially when the cover is more extensive and may not necessarily improve on the care, this in turn means that the higher the physician’s fees more extensive use of insurance accompanies (Feldstein 251). Owing to these facts managed medical care is a better option to health insurance. Access Moreover, managed healthcare plan was formulated to give healthcare access to employers whose labor force was too isolated or detached to acquire medical care on its own. In this cases, employers hired doctors and nurses. The whole idea of doing this was to increase access healthcare to those who could not through normal means. However, it was coupled with problems that were because of the above practices leading to the ratification of state-sponsored anti-corporate medicine legislation. The same plan was successful in the provision of healthcare to most workers as it followed medical practices familiar to them. On the other hand, insurance is a better option when it comes to selecting and sticking to one’s physician (Birenbaum 106). This is due to the attempt made to use certain predetermined healthcare providers by managed care providers to force enrollees. However, health insurance providers allow one to go with or use any healthcare provider of their choice. This is evident in cases where enrollees perceive a healthcare provider as inferior or inconvenient thus, will not be cooperative, or the plan will not be received well. In addition, if one changes employers or the employer changes plans, the participants may not have their doctor on the new network joined which presents a challenge in terms of quality and knowledge of participant’s medical history. In spite of all the glamour in choosing ones healthcare provider in health insurance, there is a significant disparity between insurance and managed care. This is in terms of access where if one has a disability or pre-existing condition, insurance will bring in many bureaucratic practices (Greene and Rowell 82), whereas managed healthcare will present a solution. Still, not all specialist care can be accessed through insurance, as the insurance provider needs to approve some of them while for managed care; one’s physician refers one to a specialist (Pilzer 51). In the long-term, managed care due to the network of doctors involved, one can have medical care available at any given time even during emergencies. Quality However, due to the quality of care in both palms, managed care and health insurance, have a degree of variance. For those who have health insurance, they are able to prevent diseases through early detection and recommendations by the doctor on lifestyle change. This is beneficial because it also saves on the cost that would result from a condition if at it arose. However, those without insurance are left out, as they cannot afford regular preventive checkups more so when there is no evident problem or pressing issue. It results in the uninsured having to deal with massive bills. In addition, privacy policy on patient-doctor confidentiality is not observed when it comes to health insurance because one has to disclose everything to them. As for managed care, the participants are in a better position concerning preventive care the doctor networks run an incentive system to keep the enrollees healthy thus is better off as compared to insurance. Moreover, the privacy of participant’s records is preserved except during transfer of information from one doctor to the next in the network and the competence of the medical facilities and staff is monitored by the managed care providers for ethics, responsibility and results (Kongstvedt 96). Insurance plans may or may not cover prescription medication despite the cost one has put in as premiums. However, if covered one has to pay the larger portion of the bill while the insurance provider pays the lesser. This is because health insurances are in it largely as business to make profits and not to benefit their clients. Concerning quality assurance, managed care providers do usually have an obligation to respond to complaints, of their users, within a period of 6 months. On the other hand, insurance providers are not bound to despite the option to take the case through the court system to have the dispute mediated. Conclusion Conclusively, in light of the facts presented above, health insurance plan fails, as its practices are not easily available for all to access due to inhibitive costs and bureaucratic tendencies in filing for claims. On the other hand, in managed care, although its premiums may be high sometimes, the quality of healthcare services provided is easily accessible and the best. Therefore, the managed care plan is more beneficial than health insurance, which is a profiteering undertaking. Works Cited Kongstvedt, Peter. Managed Care: What It Is and How It Works, Sudbury, Massachusetts: Jones & Bartlett Learning, 2009. Print. Birenbaum, Arnold. Managed Care: Made in America, Westport, Connecticut: Greenwood Publishing Group, 1999. Print. Feldstein, Martin. The Welfare Loss of Excess Health Insurance. The Journal of Political Economy. Vol. 81, No. 2, Part 1. (1973): 251-280. Print. Greene, Michelle and Rowell Ann. Understanding Health Insurance: A Guide to Billing and Reimbursement, Andover, Hampshire: Cengage Learning, 2010. Print. Pilzer, Paul. The New Health Insurance Solution: How to Get Cheaper, Better Coverage Without a Traditional Employer Plan. Hoboken, New Jersey: John Wiley and Sons, 2005. Print. Read More