Keystone in Health Care - Term Paper Example

? Brief Management Analysis of the Following Issues Answer1 The term managed care or managed health care is described as the variety of techniques proposed to reduce the cost of presenting appropriate health benefits to the ailing patients and also to improve the quality of patients care in the hospitals and nursing homes of United States. These organizations are also known as managed care organization or MCO. Managed care plans are also described as health insurance plans that mainly contract with the health care donors as well as the medical facilities to present total care for the members at a very lower cost. These providers or organizations comprise of a series of plans according to the type of the ailments. The amount of money to be paid entirely depends on the rules and regulations as well as the criticality of the diseases. However, restrictive plans generally cost much less as compared to others and on the other hand, flexible plans costs more. The prime objective of these types of managed care organizations is to improve the problems mainly created by the traditional insurance companies by interfering in the decisions of the payable amount and also on the type of health care selected. Other than this, MCO also tries to insert varied types of incentives and constraints into the system so as to reduce the quantity of care and the total cost when more than one treatment choice is available. There are mainly three types of plans of MCO: Health Maintenance Organizations (HMO) mainly pay for the treatment where one might select a primary care doctor for the cure. Preferred Provider Organizations (PPO) usually pay more if you get care within the network. Point of Service (POS) plans helps an individual to select between an HMO and a PPO each time when anyone need healthcare or treatment. However, managed care is now present everywhere in the U.S, but attracted huge range of controversies as it failed to achieve the total control of various medical costs. Critics and proponents are now sharply presented against managed care's overall impact in the quality of U.S. health care systems. Due to which, it is not liked or preferred by numerous patients or the families of the patients in this recent age (National center for biotechnology information, 1998). Although, MCOs operate numerous family care programs for the benefit of the members of the family still, its competitiveness is fading day by day. In spite the Family Care benefits combines both funding as well as the services from a variety of other programs, tailored according to each individual’s needs, circumstances and preferences, still due to certain misdeeds, its level of preference is lowering. But the mechanisms utilized to constrain health care consumers’ choices affect both providers and consumer behaviors. But to improve the demand of these organizations, it is essential to improve the behavior of the providers so as to retain its reputation in the market among other rivals. However, unfortunately, it is not possible as the relationship between the providers and the buyers do not remain good mainly due to mismatch in the amount of payment. Other than this, as the doctors of these organizations are merely their employees, so they work according to the rules and regulations of the providing MCO. As a result, the patients fail to achieve the best type of medical facilities or care from the health care organizations. And so the relationship between the patient/buyer and doctor do not remain in an appropriate condition. Apart from the presence of lowest insurance plans of MCO, the demand of these plans are not enhancing due to its partiality among the sellers. Different MCO organizations offer diverse type of plans, due to which, the level of preference of the buyers is lowering day by day considerably. So, the relationship among the sellers differs from one another. Similarly, the relationship of these MCO with the government is also not at all fair mainly due to faulty insurance or health care plans. So, in spite of varied other benefits, the level of dependency of these organizations are reducing in long run. And the demand of these organizations are also fading and lowering at a considerable extent. Consequently, the individuals of the community are also not at all preferring, the plans of these organizations. As a result, the range of customers and buyers are also not increasing, resulting in lowering in the amount of revenue and total profit margin of these organizations. So, in order to maintain the reputation of these organizations, it is essential to offer effective insurance policies (Jones and Bertlett, n.d.). Answer 2 The doctor–patient relationship is described as the keystone in Health care. It is the most effective medium by which varied types of information’s may be gathered, diagnoses and plans might be made, prior starting the treatment of the patient. Moreover, with the help of this information, the doctor might diagnose the type of disease present within the body and its main cause and symptoms. Apart from this, with the help of these discussions, the compliance is accomplished, along with healing powers and patient activation processes are also described. Along with this, the patient also gets huge range of support from the side of the doctors, which is extremely essential on behalf of the patients. Thus, it may be said that in case of managed care organizations, the doctor–patient relationship is also a very critical factor to increase its faith and reliability among the patients. It might prove helpful in increasing its range of customers in long run resulting in amplifications of its profit margin and revenue as well (Bovbjerg, & et al., 2003). Although the managed care organization mainly serves a definite proportion of population with resources in an integrated system of care and facilities. As service providers, these organizations provide the duties like skill, competence and fidelity so as to improve the health of the sick members. However, such duties and responsibilities are not handled in an accurate way by the doctors, and so the relationship between the doctors and the patients gets hampered. They work merely as employees for these organizations and so fail to fulfill the interests of the patients in an appropriate way. This leads to a conflicting situation among the patients and doctors resulting in a worse image and reputation of the organization within the minds of the patients. Due to which the rate of switch over increases at a higher rate as compared to others. So, the rapid penetration of the managed care organizations into the health care market enhanced the rate of concern for patients, practitioners, and scholars as it might offer a negative impact over them thereby hindering the doctor–patient relationship as well. So such concerns represent an obvious reaction on the buyers against the feared deleterious effects of this corporatization of health care practices. So, it failed to attain fame and reputation. Moreover, most of the physicians under managed care report that they are less able to offer best treatment to the patients. Along with this, they are less able to place the best interests of patients due to the rules and regulations of these organizations. As a result, the patient fails to keep their reliability and trust over these organizations (Aw-bc, n.d.). Other than this, the majority of the doctors described that the quality of health care is compromised of varied types of limitations in regards to diagnostic tests, length of hospital stay, and choice of specialists. Moreover, some other limitations are noted in the fields of the capabilities of the physician's to carry out ethical obligations and to respect patient autonomy, and to respect the confidentiality of the physician-patient communication. Most physicians also expressed that managed care also do not show any sort of impact on the ability to obtain informed consent or to present any sort of information to the patient parties. As a result, they merely get any sort of information from the side of the doctors about the health of the patients. Thus, mainly overlapping and conflicting situations may be seen among patient and doctor relationships. The interests of both the patients, doctors and health plans may overlap to a greater or lesser way, depending on the circumstances and leads to a bad remark. Thus, to improve the relationship, they try to maintain the principles and rules in significant way. They also rely on many primary care clinicians to coordinate, manage and restrain for other categories of services so as to provide the best services to the patients. With the help of these policies, they try to develop a strong relationship between primary care doctors and their patients. In addition, they also try to maintain a good doctor–patient relationship in the system that emphasizes wellness in the primary care centre (Sekhri, 2000). Hence, it may be stated that only by improving the techniques and policies of the managed care organizations, the relationship may be enhanced. And large array of new customers may be attracted resulting in enhancement of the profit margin and revenue of these organizations. References Aw-bc. (No. Date). Managed care. Retrieved from: http://www.aw-bc.com/info/phelps/Chapter11.pdf. Bovbjerg, R. R. & et al. (2003). State and federal roles in health care: rationales for allocating responsibilities. Retrieved from: http://assets.wharton.upenn.edu/~housman/files/UrbanInstitute.pdf. Jones and Bertlett. (No. Date). A distinctive system of Health care delivery. Retrieved from: http://www.jblearning.com/samples/076374512X/Shi4e_CH01.pdf. National Center for Biotechnology Information. (1998). Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine: a physician survey. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/9701096. Sekhri, Neelam. K. (2000). Managed care: the US experience. Special theme – health systems. vol.78 (6). Read More