Managed Care: Made in America - Assignment Example

Managed Care: Made in America Introduction Health care, one of the most prominent and important aspects of the medical fields require more attention. Managed care has various concerns and the lack in this field creates more pressure. The unavailability of resources and the limited availability of other equipments contribute to the existing problems. The purpose of this paper is to exhibit and describe the problems in managed care. It also describes the reasons and factors that result in a poor managed care. The major reason for such importance is the increase in the problems when compared to the past. This paper deals with the flaws and issues in the field of health care. The drawbacks and the strategies are also explained. The paper describes the need for improvement in health care and the ways in which managed care can be improved. Then the strategies are also listed with supporting arguments. Managed Care Managed care was initially developed to reduce the burden of people who seek the medical attention. Medical expenses are increasing day by day and due to this people find it difficult to deal with their medical expenses. These problems led to a situation where managed care becomes an important matter of concern. (Pre 2009). Managed care mainly deals with strategies that aim at providing quality treatments at a better cost. Even employed people find it difficult to manage their medical issues and hence managed care is considered to be an important concept. The concept of managed care takes different dimensions depending on the situation and place where it is portrayed. Managed care is commonly known as the technique used to minimize the medical expenses there by providing quality health care treatments. The main aim of managed care is to reduce the burden of the patient with the help of medical insurance and financial institutions. This is achieved by mitigating the risk to the insurance company from which a person avails his insurance. This in turn reduces the cost incurred to the patient and transfers the rest of the monetary operations to the concerned insurance firm. Ethical Concerns Managed care has certain limitations and ethical concerns which form the major part of managed care. These ethical concerns depend on the type of problem and the way in which managed care is perceived. In an organization which provides medical benefits to an employee relies on an insurance company that helps the organization to reimburse the employee’s medical expenditure. This certainly reduces and minimizes the expenses of the employee. But this may not prove to be beneficial in all the situations. (Pre 2009). Hence it is better to have a direct contact with a particular insurance company. This will be a better option as the employee will have an opportunity to get more benefits. Managed care creates pressure in most of the situations. It creates pressure to do more with the less number of available resources. The various concerns include less time per patient, less costly medicine and fewer costly diagnostic tests and treatments. Less Time per Patient This is one of the major ethical concern and people expect the managed care to allot less time to a patient so that the doctors can cover more number of patients within a stipulated time. This creates more pressure since the time allotted to a patient purely depends on the type of health problems and the treatments provided to the concerned patient. This becomes an ethical concern as the numbers of people are more. The managed care organizations generally allot a fixed time for the doctors to attend a particular patient. This becomes a problem since the patients are not satisfied as the doctors do not spend much time concentrating on a single patient. Due to this the stress level of the doctors also increases as they have very less time to attend to a specified number of patients. To improve this situation the hospitals must employ more number of doctors so that they can handle more number of patients at a particular time. Another option is, the doctors can be provided with a time schedule based on which the doctors can treat the patients. This will eradicate the problem of time being wasted on a single patient. The next matter of concern is the reduction in the cost of medicines. Less Costly Medicines Managed care must improve and the cost of medicines must also be reduced. Patients expect that the medicines must be available at a much lesser rate. The managed care organizations define a limit based on which each patient is allowed to make a purchase of their medicines. This limit also includes the cost up to which a doctor can prescribe the medicines to the concerned patient. This poses a great difficulty to the patients since the cost of medicines are higher for certain special treatments. This is considered to be a drawback and a major disadvantage. (Birenbaum, 1997). The cost of a medicine depends on the severity of the disease and ingredients used in a particular medicine. This becomes a major issue in the field of managed care and hence people find it difficult to cope up with the increasing expectations of the patients. Hence the managed care organizations must set the limit of cost depending on the treatment. This would help the patients to get more benefits from these organizations. Fewer Diagnostic Tests and Treatments Managed care organizations emphasize on the limit of diagnostic tests and treatments. This acts as a disadvantage since the doctors cannot prescribe certain tests even if they are necessary for a particular patient. In certain cases, if the doctor feels that a patient requires a particular test, then they must get the approval from the concerned insurance organization in order to proceed further with the treatment. The patients must meet the guidelines specified by the insurance and managed care organization so that their treatment can be continued in a hassle free manner. The patients expect that the hospital must provide them with fewer costly diagnostic tests and treatments. The diagnosis, tests and treatments entirely depend on the type of disease and its severity. They cannot expect the cost to be the same for all types of treatments. The cost of each and every test and treatment varies and insurance companies must include the cost of tests in their insurance coverage. The current issues and problems have led to a situation where the managed care needs to be revised and modified to suit the needs of the people. Current Issues Managed care, during its introduction was completely a new concept to the people. People did not realize its benefits and advantages. The same situation prevailed until they realized the positive outcomes and from then the industry improved at a faster pace. It was first introduced in America where most of the people get themselves insured with an insurance company. Patients felt that the managed care had various disadvantages and problems. (Kongstvedt 2009). Managed care does not include options to visit doctors according to the patient’s wish. Instead it posed certain restrictions and insisted on consulting the doctors whom the insurance companies specify. This created more problems as the patient’s preferred to consult specialists in each and every field of medicine. This turned out to be the greatest disadvantage of the managed care. Another issue is the restriction in the access to the available doctors. The hospitals insisted on consulting primary physicians for almost all types of diseases. People felt this was a great disadvantage to them since they did not have access to the doctors who specialize in a particular filed in medicine. Though some of the managed care institutions operated in a much simplified manner, people expect these organizations to provide them with world class treatments and facilities. When compared to the period when it was introduced, managed care lost its popularity and efficiency. People lost their interest to rely on managed care and this led to a situation where people completely stopped approaching them. Recession was also one of the major reasons for the people to have a second thought of relying on such managed care institutions. Due to this problem employees had to make a huge investment in order to manage their medical expenses. Strategies Managed care policies and methods can be reinvented and modified to suit the current needs of the patients. This will enable the patients to invest in insurance in order to get more benefits. The health care cost can be controlled by incorporating several other policies that reduce the costs that incur due to medical problems and issues. Managed care must implement plans that in turn include different layers. Each segment must deal with the varied medical schemes. This will certainly turn out to be a success as it will cover most of the medical treatments and tests. Agent system can also be implemented and this will enable the employees to experience the benefits. This will avoid the outpatient fees that a patient needs after a surgery or a treatment. Managed care organizations aim at making the process of treatment and health care an easier process. These organizations coordinate well with the concerned insurance company to provide the best health care to the patients. Gone are the days where care takers and care givers where given priority in taking care of a patient’s treatment and medical expenses. Managed care has become the order of the day where people rely on these organizations to process their treatments. The reason for this growth is the ability of the managed care organizations to manage and coordinate the medical expenses of the patients who enroll with them. This in turn makes health care more efficient and affordable. Though the concept of insurance companies deciding a person’s health care is not correct, people prefer managed care and insurance companies since they need not spend out of their pocket for each and every medical expense. Conclusion Managed care is one of the important components in the field of health care. It concentrated on reducing the cost and medical expenses of a patient by helping him through insurance companies. The patients experienced more benefits since they had an option of paying fewer amounts for their treatments. References Pre, A. (2009). Communicating About Health: Current Issues and Perspectives. U.S.A: Oxford University Press. Kongstvedt, P. (2009). Managed Care: What It Is and How It Works. U.S.A: Johns & Barlett Publishers. Birenbaum, A. (1997). Managed Care: Made in America. California: Praeger Publishers. Read More