Pros and Cons of Managed Care in America - Coursework Example

Pros and Cons of Managed Care in America al Affiliation Table of Contents Introduction ……………………………. ……………………………………. 3 Overview ………………………………. ……………………………………. 3 Pros of Managed Care………………………………………………………… 4 Cons of Managed Care…………………………………………………………4 Challenges Associated with managed Care…………………………………… 5 Recommendations and Conclusion …………………………………………….5 References ………………………………………………………………………6 Introduction Managed care is a healthcare system that integrates payment techniques and the delivery of quality healthcare (CSU, 2004). The system is especially gaining fame among employee health management in the United States. The aim of managed care system is to avail quality healthcare by making it accessible and affordable for every citizen in the nation. The system has key elements that distinguish it from other health policies. Managed care has exclusive standards for selecting providers. Managed care is also associated with formal programs to ensure quality improvement and a review of how the services are being utilized. Beneficiaries of the managed care system are also charged with the role of keeping healthy to minimize the cost of medical care (Kongstvedt, 2007). Finally, the system is characterized with financial incentives. The working principle of managed care is to provide affordable healthcare through cost administration. This in that, people get healthcare services at a standard cost irrespective of the ailment. The system also presents a major concern as there is a risk of comprising ethical standards. Managed care is associated with a number of advantages and disadvantages as explored (Carlson, 2009). The paper serves to illuminate the consequences of managed care in the government and also on the people of America. Overview of managed care in America The origin of managed care in America dates as far back to the 1910-1940s through non-profitable organizations (CSU, 2004). The organizations would contact doctors and deploy them to rural areas and other needy areas to provide health services to the people at minimal or no cost at all. The efforts of the organizations were as a response to the rising medical costs provided by the private sector. Managed care also arose from employee health care policies that date to the 1970s and 1980s. The employers would contribute a monthly fixed percentage of money to health insurers to cover their employees. The insurance company would then cover the rest of the medical costs when the employees fell ill. The plan of managed care was advantageous to both employers and employees in that it led to reduced medical costs. By the year 1999, three-quarters of the insured population and approximately half the number of registered doctors were all under managed care (Kongstvedt, 2007). Over the last two decades, 150 million American are benefiting from managed care through different policies (Carlson, 2009). The consequences of managed care have both negative and positive effects. A major concern is the risk of compromised care that the system is supposed to protect. The major advantage is that now many Americans have access to medical care that has led to improved health and an overall improved quality of life. The pros and cons and emerging impacts of managed care are discussed in the context. Pros of managed care in America Managed care has become the evolved form through which health services are financed and organized in the United States (Kongstvedt, 2007). The evolution of managed care has been driven by a number of advantages that made the policy easily acceptable and adaptable. The major attraction of managed care to most citizens is the availability of quality care at a minimized cost. The system provides for medical care at a standard cost, irrespective of the treatment regimen. People with lifelong diseases such as ailments arising from disabilities, diabetes, arthritis, and hypertension can afford quality care for as long as needed without a straining financial burden (McKenzie, Pinger, & Kotecki, 2012). People suffering from malignancies that are expensive to treat can now lead a comfortable life due to the improved treatment outcome at a low cost. Cost administration, has especially benefited people from rural and poor backgrounds who could not afford quality medical care. The reduced cost of medical services and medications have improved the health outcome in the nation, and people can enjoy a quality life. Managed care has also made quality care accessible to every citizen despite their geographical location or financial background. Before the launching of the managed care programs, private health care was very expensive, and only few people could afford it which limited accessibility. Managed care has made quality health care accessible through two main ways. First, qualified doctors are contracted and deployed throughout the country to ensure easy accessibility. The second way is through lowering of costs, hence granting everybody a means to afford healthcare. Another advantage is that all medical workers who are contracted first have to be accredited. This provides serenity to the patients as they are assured of quality services contributing to their physiological healing. Research carried out shows that for people to maintain good health, they must achieve both physical and emotional healing. Managed care is also comprised of programs that facilitate early detection of diseases and preventive measures. This is also an advantage as early detection translates to early treatment and improved probability of full recovery. It also helps in the management of potentially fatal ailments such as cancer and prevention of onset of chronic diseases such as arthritis and diabetes (McKenzie, Pinger, & Kotecki, 2012). However, not everything is a positive when it comes to managed care as it is encountered with some major disadvantages that threaten the stability of the policy. Cons of Managed care in America The primary obligation of health workers in health maintenance organizations is patient welfare. Managed care system threatens that obligation through a number of ways. The main shortfall of managed care is the rigidity in rules when it comes to the choice of the preferred physician by the patient (Jecker & Braddock, 2008). Patients have no choice over their health maintenance organization or the attending health worker. Patients are beneficiaries of healthcare from healthcare providers under specified organizations. This may affect the psychological healing of the patient as they may not have confidence with the assigned doctor. This limitation on choice of preferred physicians also affects the compliance of the patients, and this influences the healing process negatively. In cases where the patient is not satisfied with the care provided by a particular organization, they are not covered to seek help from other health workers (Verheijde, 2006). If they chose to seek health services outside the contracted organizations, they are forced to cater for their expenses. This limitation also affects the referring of patients to specialists. Doctors are limited to referring their patients to specialized doctors if they happen to fall under a different organization or may not be contracted. There is also an ethical concern presented as the doctor may refrain from administering proper healthcare (for example, conducting expensive diagnostic tests) to avoid incurring the costs (Jecker & Braddock, 2008). Challenges associated with managed care The challenges encountered in the implementation of managed care are due to the rising cost of medical care and changes in legislation. In the labor sector, the business and consumer power are being affected by the increase in healthcare costs. The rising costs of medical care are attributed to the presumed carelessness of the employees (Jecker & Braddock, 2008). This is because they know that they are covered by their employers in case of any ailments. The medical field is also characterized with advanced technology that is expensive. This has led to an increase in healthcare costs, which threatens the quality of services being provided. Implementation of changes by the legislature towards the maintenance and governance of managed care take a long time (CSU, 2004). Therefore, the employers feel discouraged as the changes they want implemented are not being effected as soon as they are needed. They, therefore, refrain from offering effective and efficient managed care to their employees as it is not economically viable. Recommendations and conclusion Payment systems such as co-payments by the employee and the employer should be implemented (Verheijde, 2006). This will deter the wastefulness of medical facilities and service usage, hence reducing the cost. The use of cheaper generic drugs should be encouraged rather than going for the original drugs which are expensive. Taxation of the healthcare sector by the legislature should be reduced to lower the cost of medical care. The legislature should also be transparent in their acquisition of medical technology and products. These solutions will be cumulative to better cost administration, hence increased availability and accessibility of quality healthcare. The cons including ethical concerns and restriction to healthcare providers can all be resolved through effective legislation. Ethical concerns, which pose health deterioration risks, can be resolved by ensuring that the system generates enough profit for the doctors. References California State University (CSU). (2004). Managed Care Introduction. Retrieved 17 August 2014, from http://www.csus.edu/indiv/h/heflintl/group/section-1/group-5/Website/Whole%20Document.htm Carlson, G. (2009). Managed Care: Understanding our Changing Healthcare System. Health Feature Articles. Retrieved 17 August 2014, from http://missourifamilies.org/features/healtharticles/health39.htm Jecker, N. S., & Braddock, H. C. (2008). Managed Care: Ethics in Medicine. University of Washington School of Medicine. https://depts.washington.edu/bioethx/topics/manag.html Kongstvedt, P. R. (2007). Essentials of managed health care. Sudbury, Mass: Jones and Bartlett Publishers.Bottom of Form McKenzie, J. F., Pinger, R. R., & Kotecki, J. E. (2012). An introduction to community health. Sudbury, MA: Jones & Bartlett Learning. Verheijde, J. L. (2006). Managing care: A shared responsibility. Dordrecht: Springer Read More