Healthcare Analyzation: Pros and Cons of Managed Care in America - Research Paper Example

Healthcare Analyzation: Pros and Cons of Managed Care in America Table of Contents Table of Contents 2 Background 4 The Challenges and Problems Associated With Managed Care in America 4 Literature Review 6 Problem Analysis 7 Recommend Solutions 7 Implementation of Solutions 8 Justification 8 Summary and Conclusion 9 Works Cited. (APA) 10 Introduction Managed care is regarded as a prepaid and comprehensive process associated with the healthcare facilities. It is a system of healthcare delivery that includes primary, specialty and preventive health services among others. The in-depth meaning of managed care essentially reflects the various techniques being involved with the provision for healthcare benefits. Managed care assists in the reduction of cost being incurred in deriving the healthcare benefits. This particular technique further helps in the improvement of the quality associated with the healthcare provision. Within the United States, there exists a range of private and competitive sectors pertaining to the healthcare industry. Correspondingly, managed care as a process has gained elevation and importance in the US. The rise in the cost along with competition within the healthcare sector has given way to the implementation of the managed care process. Managed care incorporates certain elements within it that ensure effective derivation of the healthcare services. It entails explicit standards to make it easy for the providers. Besides, it acts as a formal program that assists in the improvement of the healthcare sector along with utilization of the resources for accelerated benefits. Managed care process lays a greater emphasis on the enrollee’s health with a motive to reduce their use of services. It is a system that connects the financing and delivery of the healthcare services. There exist various units under the managed care such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Point-of-Service plan (POSs) among others (Tobin, n.d.). This study intends to discuss various challenges along with pros and cons associated with the implementation managed healthcare system within the USA. The study will direct its focus on the challenges and problems being faced by the managed care system along with its implementation, solution and analysis. Background In the recent scenario, the health care industry within the United States has become more complex and has exhibited a plethora of changes within it. It has been observed that the American healthcare industry has undergone major changes in terms of services being provided and the quality of facilities offered. There exist various factors that are acting as the key drivers for bringing this particular change. These factors contribute greatly in the development of the managed healthcare system. Furthermore, the complex nature of the US healthcare industry has given rise to the numerous challenges pertaining to the provision for health services. Managed care system has been developed with a view to mitigate the emerging challenges associated with the complex healthcare industry. It assists in cost saving, providing reimbursement and ascertaining improvement of the quality aspect. In fact, it is revealed that before the development of managed care, the clinicians mainly practiced medicines without considering the cost being incurred. With the establishment of managed care, cost and necessity, both are considered to be an important part associated with the healthcare industry (Bergman & Homer, 1988). The Challenges and Problems Associated With Managed Care in America The spread of managed care within the US reflects the healthcare system being undertaken by the American public and the policymakers. It has been further explained that challenges with respect to the managed healthcare system take into account both the professionals and the providers. The significant areas pertaining to the healthcare industry that face the challenge of managed care include ethical, legal and regulatory issues. In fact, an in-depth analysis along with observations has further revealed that the managed care system is reducing the inclusion of latest technology in the healthcare sector. Apart from this, it has also been depicted that managed care at times worsens the relationship between the patients and the professionals. Besides, this particular healthcare system has greatly interfered in the personal preference of the patients in case of medical treatment. The implementation of managed care has hampered a patient’s ability to choose and select the professionals of own preference. In this regard, if the patient receives treatment from the preferred professional, he/she is likely to gain confidence on the treatment and the entire process would be effective. Moreover, the provider or the patients become competent enough to undergo a treatment plan. Managed care creates a hurdle in the execution of effective communication among the physicians and the patients. Further researches have also revealed that managed care limits the treatment of the professionals. It also limits the ability of the doctors with respect to referring to the specialist. By extensively interfering within the process of treatment, it limits a patient’s trust upon the doctors. Another vital issue that managed care faces can be determined to be the scheme associated with the salaried employees. In accordance with this scheme, it rewards the professionals along with the hospitals for limiting the provisions related to medical services that lays an impact on the area of interest. Earlier, it had been argued that providing fee services to the patients hinders the capability and the desire of the professionals to serve more. Nevertheless, in real sense, medical services at a lower cost does not hinder the professionals’ treatment rather it increases the patients’ relationship with them which actually proves to be beneficial for effective treatment (Hall, n.d.). Furthermore, the other area which creates deterrence from deriving the benefits being attached with managed care is psychiatric treatment. It has been observed that the psychiatric treatments were previously covered under the traditional insurance plans related to the health sector. In the recent scenario, mental health problems are taking a toll as the major problem, as maximum people suffer from this complication (Northrup, 2011). Another major challenge faced by managed care system is related to the manager, who deals with all the operational aspects. It has been noted that in recent managed care system, the manager being appointed endures no prior knowledge related to healthcare sector that hinders the effective management of the entire process. The main aim of such system is to provide effective treatment to the providers at a lower cost. However, clinical leadership being executed limits the effective performance and thereby the aim directs towards profit maximisation rather than optimising the patients’ care. Apart from the above mentioned challenges, it can be ascertained that managed healthcare system endures certain advantages as well. As observed, the healthcare reforms are changing the various patterns being involved in the medical treatment. This further enhances the efficiency of the medical facilities being provided by managed care. Besides, the implementation of managed care has helped in the reduction of streamline cost. Apart from this, the other added advantage of the application of managed care is the fee-for-service model. In accordance with this model, it is getting transformed into value based services. The application of managed care system meets up the requirement of the differentiated aspects pertaining to the medical treatment. Managed care provides coverage to the medical requirements, which has turned out to be one of the costliest affairs in recent times (Koren & Writer, 2009). Literature Review Controlling the cost being incurred in the healthcare sector has turned out to be a major challenge for the public along with the private healthcare system within the United States. In recent scenario, the spending related to medical treatment showed a rise from 8% to 14.8% of the entire Gross Domestic Product (GDP) in the year 2009. The ever-accelerating cost of the medical treatment has taken its toll on the US government spending. In this regard, it has been mentioned that stabilisation associated costs incurred in the healthcare sector mainly coincides with that of the managed care uprisings (Pinkovskiy, 2013). According to the views of Bundorf & et al. (2004), the implementation of managed care within the healthcare industry has laid a greater impact on the patients under managed care as well as non-managed care in terms of the delivery of the medical treatment. Correspondingly, it has been further ascertained that the financial incentives being provided to the insurers covered under the plan lays an impact on them. The plan ensures the effectiveness of the process, outcome and the cost being incurred with respect to the managed care system. In case of the managed care provisions, it is significant on part of the system to bring about changes within the patient care (Bundorf et al., 2004). Managed care system has generated a spillover effect. This effect increases the competition within the healthcare industry. Apart from this, the spillover effect will result in the structural changes of the entire healthcare sector. In fact, in-depth observation reveals that the penetration of managed care level has lowered the rates of the health care costs being incurred. Managed care system further controls the hazard associated with the application of medical care (Bundorf et al., 2004). Pheifer (2010) has provided an overview related to the problems persisting within managed care. It has been determined that the providers have faced challenges while dealing with the entire complex paper works. Furthermore, the providers have also faced difficulty in terms of deriving approval pertaining to medical treatment. The entire process within managed care creates a hurdle in deriving proper medication on time. According to the assessment made by University of Washington (1998), relationship concerns frame a vital part of managed care system. It has been noted that managed care creates a hurdle in the development of effective relationship between the professionals and the providers. In case of managed care system, the organisations working under it provide their own physicians to the concerned provider. This further creates a hurdle in building up of effective relationship amid the doctors and their patients. According to the views of Silberman & James (2000), it usually becomes difficult for the providers to understand the entire network related to managed care. It has been further ascertained that written documents related to the regulations and norms associated with managed care will not suffice the basic requirement i.e. making it easily understandable to the providers (Silberman & James, 2000). Problem Analysis As the entire process of managed care is complex, it at times creates certain major loopholes that might result in ethical concerns. The entire procedures framed under managed care essentially create certain problems for the provider. The associated challenges have been discussed in this segment. It is observed that the foundation of the relationship between the providers and the professionals entirely relies upon trust and confidence. Implementation of managed care lays a potential impact on the relationship of physician-provider. In accordance with the Oath of Hippocrates, trust frames an essential and significant element of the obligation, which the physician holds with regard to their patients. Consequently, it is the responsibility of the physician to keep the personal information regarding their patients preserved. Whereas, in this regard, the managed care process creates a conflicting situation for the physicians. Managed care system essentially creates conflict for the physicians with respect to balancing of interest between their patients and the other patients. Apart from this, implementation of managed care also creates conflict between the patients’ requirements and the physician’s financial interest. This happens as the managed care system designs the plans related to bonuses along with fee withholds in order to make the physicians more cost conscious. This lays an impact on the decision of the physicians pertaining to the preferred tests as it will influence their income. With the advent of managed care, the entire system associated with the healthcare sector has widely changed. This has resulted in the creation of a hurdle in establishing relationship between the physicians and the providers (CEJA, 1995). Recommend Solutions In keeping with the discussion made previously, the key challenges that the managed care system faces is its entire process, which depicts complexity. In order to effectively apply the benefits being attached with managed care, few changes are needed within it. As the major problem lies amid the relationship of the physicians-providers, it is necessary for the management of the system to apply certain recommendations. The management can make changes in the form, which the providers’ fill for acquiring the benefits. In the form, a mentioned column can be inscribed that states the information of the previous treatment records and the concerned doctor. In addition, another pertinent recommendation that can be given is including specific plans associated with the psychiatric treatment within managed care. This will in fact enable to improve the condition of the patients to a greater extent (APM, n.d.) As mentioned the challenge, which managed care faces with respect to the managers recruited, requires a change as well. Therefore, it can be recommended that while recruiting the manager for the post of managed care system, it is important to select the person having prior knowledge with regard to the healthcare sector. These recommendations might help managed care system to execute its policies effectively thereby providing ample benefit to the patients. Implementation of Solutions With respect to the implementation process of the provided recommendations, it involves certain stages. At first instance, it is necessary for the management of managed care to review the prevailing regulations and norms. In fact, the management can review the previous year’s reports in order to derive the efficiency of the plan being executed. Apart from this, the management must make plans in order to analyse the benefits of the plan and its associated effectiveness. In order to attract more providers for the insurance plan, it is necessary to include the aspect that will provide better delivery of healthcare. After the review of the prevailing regulations, the management can consider these recommendations. On the basis of these recommendations, new policies and regulations can be framed. This new set of regulations must be reviewed gain with an objective to provide accelerated benefits to the providers. In this way, the recommended policies will be incorporated within managed care system thereby developing the healthcare services. Justification It can be acknowledged that the recommended plan being framed is essential in order to accelerate the services offered by the providers of managed care. In this regard, it can be further ascertained that by implementing the strategies managed care will be capable of providing better advantages to the providers. With regard to a better managed care plan, the providers would be able to acquire medical insurance that entails better coverage. Besides, the providers would be able to maintain their valued relationship with the physicians. This will further result in the acceleration of the delivery of the healthcare services. Mental health issues in current scenario are regarded as one of the top concerns for the health care industry. Provision for the psychiatric treatment under the coverage of managed care system will ensure effective delivery care in this particular treatment. As mentioned above previously, psychiatric treatment was under the coverage of the traditional insurance plan. This latest implementation will provide a better leverage to managed care. Thus, the entire recommendations being provided within the study might prove beneficial for the providers under the coverage of managed care system. Summary and Conclusion Managed care plan is a system within the US that provides people with medical benefits. The coverage plan assists in the reduction of the costs being incurred in the medical treatment. It has been ascertained that accelerated medical cost has become a major concern for the US government. Therefore, this particular healthcare plan will ensure lower cost pertaining to the medical treatment. The inclusion of managed care plan will further ease the process of medical treatment. However, the inclusion of managed care also reflects certain disadvantages. The process being designed under managed care system is quite complex. It becomes difficult for the providers to understand the entire execution of the process. Additionally, due to the extensive interference of managed care system, it is creating a hurdle in the establishment of the relationship that exists between the physicians and the providers. The literature review of the study reflects the impact of managed care system on the healthcare industry. The problems associated with this particular system include certain conflicts. The conflicts arise in terms of the interests of the physicians pertaining to providing treatment to their own patients and to the others. Recommendations have been provided to implement certain new strategies that will lay a greater impact on the policies of managed care system. It is determined that a proper focus on streamlining the managed care system can enable to achieve the desired objectives from such an innovative healthcare facility. The utmost benefits from the system can ultimately be attained if the service providers and patients derive due correlation in the process of service delivery. Most importantly, the inherent conflicts and complexities need to be dealt with prudently so that the key purpose of managed care is attained. Works Cited. (APA) APM. (n.d.). Managed care: psychiatric consultation services for medical/surgical patients. Retrieved from http://www.apm.org/papers/managed-care.shtml Bergman, D. A., & Homer, C. J. (1998). Managed care and the quality of childrens health services. Journal Issue: Children and Managed Health Care, 8(2). Bundorf, M. K., Schulman, K. A., Stafford, J. A., Gaskin, D., Jollis, J. G., & Escarce, J. J. (2004). Impact of managed care on the treatment, costs, and outcomes of fee-for-service Medicare patients with acute myocardial infarction. Health Serv Res 39(1), 131–152. CEJA. (1995). Ethical issues in managed care. Report 13, 1-11. Hall, R. C. W. (n.d.). Ethical and legal implications of managed care. Retrieved from http://www.drrichardhall.com/ethical.htm Koren, J. R., & Writer, S. (2009). The pros and cons of managed health care. Retrieved from http://www.dailybulletin.com/general-news/20090929/the-pros-and-cons-of-managed-health-care Northrup, G. H. (2011). How managed care caused the mental health care crisis. Retrieved from http://www.kevinmd.com/blog/2011/05/managed-care-caused-mental-health-care-crisis.html Pinkovskiy, M.L. (2013). The impact of the managed care backlash on health care costs: evidence from state regulation of managed care cost containment practices. Federal Reserve Bank of New York, pp. 1-53. Pheifer, T. (2010). Managed health care. Retrieved from http://www.livinghealthy360.com/index.php/managed-health-care-17533/ Silberman, P., & James, K. (2000). Managed care regulations: impact on quality? Quality Management in Health Care, 21-39. Tobin, C. (n.d.). What is managed health care? Retrieved from https://nfb.org/images/nfb/publications/vodold/mngdcare.htm University of Washington. (1998). Managed care. Retrieved from http://depts.washington.edu/bioethx/topics/manag.html Washington State Health Care Authority. (2014). APPLE health (Managed Care) medical programs. Retrieved from http://www.hca.wa.gov/medicaid/healthyoptions/pages/index.aspx Read More