Overview of Managed Care in the United States - Essay Example

? Managed Care Overview of Managed Care The term ’managed care’ is primarily used in the United s to define health insurance strategies that synchronize excellence and cost of care for its registered members. It signifies when any person enrolls into the managed care then the person selects a doctor, who will take the responsibility about the healthcare of that person. He/she is also called primary care physician (PCP). The PCP is usually required for the patients who select healthcare officers from the available managed care network plans of hospitals (Department of Health, 2013). Primarily, managed care is a healthcare procedure that covers cost-containment strategies, risk provision among insurance units, employers and providers, administration and reporting thereon. It has been developed to address the crisis like scenario arising from rapidly rising medical costs in the previous era (International Foundation of Employee Benefit Plans, 2003). The techniques introduced under managed care facilitate to not only reduce healthcare costs but also ascertain developed quality of care. A majority of cost reductions in managed care has emerged through negotiating, at times dictating, reduced rate of reimbursement related to doctors, hospitals along with other ancillary services (Harrington & Estes, 2008). The main objective of this essay is to reveal the reasons behind signifying managed care as one of the main components of United States healthcare system and its impact on healthcare spending from the viewpoint of the Affordable Care Act. Moreover, the essay will also facilitate to know why the exposure to the healthcare costs is threatening for the stability of American families. Perception about the future allied with managed care from a leadership perspective will also be provided. Describe Managed Care As A Component Of The U.S. Health Care System And Its Impact On Health Care Spending From The Perspective Of The Affordable Care Act. Managed care, as a component of the U.S. healthcare system, has in the past decade played a vital role to bring in stability amid the citizens. In the US, the healthcare cost in the past ten to twenty years had increased at a variable rate. In the early 1990s, the healthcare cost started to reach an alarming figure which often became out of reach of common citizens. At that time, managed care had been quite effective in clamping down upon the rate of rise (Kongstvedt, 2004). The US healthcare system has been facing a critical need to address the growing demand for providing affordable care to its citizens. Contextually, managed care has been able to pave the path for such a turnaround in the healthcare system. Managed care has changed in response to buyers’ demand to control costs. The main principle of managed care system is to provide high quality service. It is also responsible for maintaining the care of population through the use of healthcare system that synchronizes care and monitors the whole range of services. Managed care also highlights the health education. They also provide outpatient clinics, primary care physicians (Mukau, 2009). Managed care has a vital impact on healthcare spending from the perspective of the Affordable Care Act. Through the use of managed care process, the growth of healthcare costs can be afforded in a cooperative and inclusive manner. With the help of this process, the Affordable Care Act becomes much beneficial. It helps to lower the cost of health care, healthcare plans can be connected with the new providers and high value system for the patients can be ensured. With the aid of managed care system, Affordable Care Act fulfills its two key health issues that include healthcare cost and fragmented healthcare delivery. It is also beneficial because it is an incorporated tool that helps in a coordinate manner. Through this process Affordable Care Act can ensure provide quality healthcare service to required individuals (Navarro & Cahill, n.d.). Explain Why Rising Exposure to Health Care Costs Is Threatening the Well-Being of American Families  Healthcare cost is continuously rising in the US. There has been a significant reduction in the amount of employers covered under workers-base plan. According to the annual report of Milliman, the rate of increase in healthcare cost has been by US$1,319, a 7.3% rise in the year 2010-2011. Through this study, it was examined that cost rise in terms of health expenditure focused on changes in fees while ignoring the area services. Increasing healthcare cost did not positively affect all insured Americans. Adults with high deductibles in addition to those with individual and employer based coverage have higher out-of-pocket medical expenses than adults with lower deductibles. Moreover, in this regard, families belonging to higher social class conveyed their problems in time of paying the medical bills that they felt depressed to pay such high bill amounts which increase their credit card debt. The destruction of a broad range of employer coverage excessively affects those who are most at risk. A few percentages of people whose income is less than US$60,000 spend huge amount of money in medical expenses. Employer coverage is a natural tool for the employer which looks after the wellbeing of the employees. It is further observed that people generally select individual insurance market for their health benefit, which in turn at times creates an obstacle for them. Some of the states have been providing individual insurance market for covering the medical plans. On the other hand, certain states in the US have denied 46 million of American medical insurance. In the meanwhile, separate market guidelines have been offering some amount of coverage for the less healthy people and have supported largely the younger people through coverage. Thus, these facets are threatening the wellbeing of American families (Wilper, Woolhandler, Lasser, McCormick, Bor & Himmelstein, 2009). Explain Your Personal Perception of the Future of Managed Care from a Leadership Perspective Focusing On Key Issues Related To Health Care Costs/Spending With regard to individual perspective, it can be said that the need for managed care providers will rapidly extend. The recent Supreme Court result on the issue of Medicaid growth helps people to move forward. In relation to the issue of healthcare costs or spending, the future of managed care has become common to public sector as a part of indication of future private sector reforms. From the companies’ point of view, they are interested in adopting the new delivery system and purchasing models. A minority of employers want to change the healthcare plan. They want more choices along with controls by the customers and employers and a majority of them are looking to multiple networks and significant cost savings plans. From a leadership perspective, it can be said that managed care needs to design a plan for future that would help the low cost providers. Moreover, the low cost providers desire to use expensive hospitals for certain procedures. Managed care should design a plan for the members who select more cost efficient providers. Cost saving can be predicted through modeling of member movement. Therefore, such kind of initiatives can enable facilitate to ensure superior managed care (Fuchs, 2009). References Department of Health. (2013). Managed care. Retrieved from http://www.health.ny.gov/health_care/managed_care/ Fuchs, V. R. (2009). Eliminating “Waste” in Health Care. Health care reform in United States, pp.1-29. Harrington, C. & Estes, C. (2008). Health policy: Crisis and reform in the U.S. health care delivery system. Sudbury: Jones & Bartlett Publishers. International Foundation of Employee Benefit Plans. (2003). Managed care. Retrieved from http://www.ifebp.org/pdf/harker/Managed_Care.pdf Kongstvedt, P. R. (2004). Managed care: what it is and how it is works. United States: Michael Brown. Mukau, L. (2009). American Health Care in Crisis: Fundamentals of Health Care Reform. American Journal of clinical Medicine 6 (4), pp. 32-46. Navarro, R. P., & Cahill, J. A. (No Date). Role of managed care in the U.S. healthcare system. Retrieved from http://www.jblearning.com/samples/0763732400/32400_CH01_Pass2.pdf Wilper, A. P., Woolhandler, S., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2009). Health Insurance and Mortality in US Adults. American Journal of Public Health 99 (12), pp. 2289-2294 Read More