Managed Care - Impact on Quality - Essay Example

Managed Care Impact on Quality Managed care has altered the experience of patients in terms of care giving. This changed system of providing care haseven resulted in developing the experiences of people with respect to care. Correspondingly, to provide efficient care the managed care organizations have adopted various measures those are usually involved with controlling costs and developing the quality of care being provided, which includes primary care, profiling of physicians and disease management among others. However, there is no specific elaboration available for developing the idea of management for developing a proper system of care. It is thus noted that based on the roles played by people for disease management it could be defined as a process of educating people to minimize the burden imposed by diseases. It is in this context that the patient’s reaction to a specific level of care giving is dependent on their individual need. These needs are based on the fact that whether they wish to avail quality care or avail care at a cost effective manner. The perceived believes of people often rejects the concept of gate-keeping to be a proper tool for maintaining quality care. Conversely, people well accept the concepts of disease management to improve the quality of managed care among patients (Zimlichman, Mandel, Mimouni, Vinker, Kochba, Kreiss & Lahad, 2005). Notably, there is a lot of uncertainty prevailing in terms of the influences caused by the terms of actual care in respect to the perceptions of care that a person assumes. Furthermore, the attempted managed care practices are noted to be having a huge amount of complications that could be identified to be a reason of the inconsistent definitions provided by the different authors on the specific topic. Correspondingly, it can even be noted that there are various limitations to the expected level of care giving, specifically in terms of managed care. These types of limitations are available for both maintaining quality and establishment of cost effectiveness. Hence determining the exact amount of quality care is subject to severe amount of complexes that are noted while assessing the various needs of managed care. Reviewing the experiences obtained from the private sectors, it is evident that certain managed care services are ineffective also denoting that the managed care services are even dropping certain plans, which are more inclined towards providing cost effectiveness than improving care. Notably, Harvard Pilgrim Health Care situated in New England terminated their use of gatekeepers in the year 1997. This termination was an outcome of the fact that there was lack of evidences that supported the change in the referral patterns (Lee, Estes & Rodriguez, 2003). Considering the fact that consciousness about healthcare is rising in numbers, the managed care services related with cost control may be reconsidered. Managed Care Organizations (MCOs) herein claim that their prime motive is to initiate the delivery of effective care in a cost effective manner. Notably, the MCOs opt for delivering quality care at a cost effective way and develop the quality of care giving. However, theorists who are in support of managed care argue that there is no evident impact on the patients in terms of providing quality care. Additionally, supporters even use the previous studies conducted in the relevant field to support their notion about managed care. On the contrary, the reviewers of the managed care systems are of the notion that many of the studies conducted in the specific filed are most outdated. Furthermore, the investigations and studies conducted through children are conducted at the time of availing Medicaid plans discussed previously (Lee et al., 2003). Additionally, it is even noted that depending on the review of the recent years, computations of the various cost containment does not fall into the needs of the present years of operations. This notion was largely supported by evidences collected from the survey of consumers affirming the fact that there is a perceived decrease in the quality of care in terms of the price of such services (Lee, Estes & Rodriguez, 2003). The three ways, which affect the quality of providing care less than the managed care system, are listed below. Limiting the Benefit Package Several public and private health care providers work in alignment with MCOs and other groups providing medical services in order to initiate various healthcare products of varying degrees to enhance their quality of health service providence. By reducing the scope of the insurance packages, the insurers have been successful in reducing cost. However, this strategic reduction in packages has affected the overall outcomes of availing such services (Lee et al., 2003). Restricting the Provider Network To increase the networks and initiate the providence of the different health care services, the MCOs are enhancing its network with other health care providers. This acts as a positive move, as it enhances the ability of the providers to meet the diverse needs of the enrollees. By developing a provider panel, proper care to the patients could also be ensured. Notably, the development of small provider panels would help in maintaining an adequate patient base and develop quality care for patients. The existing health care providers can herewith manage to develop effective care at lower fees and would assist the participants to avail physician of their choice. It was noted from a survey conducted in the year 1994 within the managed care plans operating at various societal domains that only 28% of the respondents could avail services from their physician of choice (Lee et al., 2003). To reduce the chances of discrepancies, both the large as well as the small groups of care providers proved to be inefficient. Moreover, it is even noted that loosely managed organizations providing support for managed care leads to inefficiency within the operations and blocks the path of giving better quality care to patients. Thus, it can be ascertained that in order to achieve quality care for the patients, the management of the panels are one of the most important aspects of care giving. Correspondingly, the financial care provided also differs between the traditional services and present managed care arrangements (Lee et al., 2003). Manipulating Clinicians Financial Incentives The service programs that are operating within the system are varying in terms of their fee services that are required for availing the services. Identifiably, the needs of reimbursement of the provider are based on the number of units of service he generates. The chances of overutilization of healthcare facilities are thus noted to be quite high for high amount of reimbursement received for the same. Whereas on the other hand, if the reimbursement are too low, the chances that there will be a huge lack of proper care that is provided to the enrollees. This type of issues was prevalent among the Medicaid services where due to low amount of reimbursement, people failed to receive proper care. Certain financial arrangements that were commonly made within the system were also expected to lower the risk of financial assessment. Correspondingly, the reimbursement techniques, such as shared risks as well as reimbursement through the mode of salary can lead to underutilization of necessary services (Bergman & Homer, 1998). Impact on Physician Care Notably, the changed system of healthcare is even having a huge impact on the peripherals of healthcare system. Physicians are accordingly observed to be entering into business sharing to develop their businesses and retain their old patients. Identifiably, some physicians are joining individual contracts with the healthcare units whereas others are joining larger organizations setting up contracts with Health Maintenance Organization (HMO), Point-Of-Service (POS) plans as well as Preferred Provider Organizations (PPOs) among others (Feldman, Novack, & Gracely, 1998). The following study correspondingly evidences the fact that the physicians were having an identifiable impact on many of their professional obligations, When questioned, the physicians reflected on their views of managed care based on three major criteria, namely the relationship among the physician with their patients, their ability to initiate their professional as well as ethical obligation, provide quality care to patient among others. A survey conducted in 1996, where 1011physicians belonging from the primary care sector was observed and analyzed on a Likert scale, the physicians were observed to be spending around 9.4 years caring for patients under a managed care system. It was also noted that the preponderance of the respondents were practiced from the last 15 years. The respondents belonged from diverse professional backgrounds and were within an average age of 48.9 years. Additionally, 77% of the overall data were collected from respondents who were male (Feldman et al., 1998). It was also noted that the findings of the survey were represented using five methods noted on the Likert scale. The five segments of the scale were reorganized into three categories that broadly reflected on the fact that the scales were properly managed and the responses collected likewise. Notably, the exact number of respondents varied for each question and ranged from 541-555 as well as from 419-426. The following figures reflect on the various results received from the data collected and even affirm the various results thus obtained (Feldman et al., 1998). Figure 1: Effect of Managed On Primary Care Physician-Patient Relationship (Source: Feldman et al., 1998) Figure 2: Effect Of Managed Care On The Ability Of The Physician To Carry Out Ethical Obligations (Source: Feldman et al., 1998) Figure 3: Impact of Managed Care Limitations on the Quality of Patient Care (Source: Feldman et al., 1998) Figure 4: Agreement with Statements about Managed Care and Patients Enrolled In Managed Care (Source: Feldman et al., 1998) Figure 4: Frequency of Goals Achieved Under Managed Care (Source: Feldman et al., 1998) The above figures represent the findings that were obtained in the due course of analysis. Notably, the positive responses received from the finding were much less frequent than the negative ones received. However, a major section of the participants responded in neutral or negative responses. It was only in the 5th option that the respondents replied on an equal amount of positive and negative responses (Feldman et al., 1998). Physician-Patient Relationships To develop a proper effect of the healthcare system, a positive relationship between the patient and the physician is identifiable. Around 75% of the total respondents affirmed that the managed care had a very negative impact on the overall process of managed care. Furthermore, the respondents even affirmed that they were more inclined towards serving greater number of patients than developing the quality care for patients. This approach of the physician is also likely to adversely affect the complete healthcare system and consequently, affect the mentalities of the people to avail the proper healthcare needs. This reduced relationship among the patients and physicians was also observed as likely to reduce the chances of proper medical decision-making and adversely affect the overall system of managed care (Feldman et al., 1998). As an impact of the managed care system, the patients often noted the physicians to be adversaries. However, the role of gatekeeper of the physicians could even be viewed to be in the positive axis, as it safeguarded the patients from a situation of over treatment. Conversely, this affected the overall relationship of the patients with the physicians and inhibited the freedom of their clinical care providing. This trend has further been affecting the overall development of the quality care practices. Notably, the physicians were noted as having a huge effect on their level of obligation and commitment towards the job that imposed a huge impact on the overall management of the healthcare needs. Commendably, this lack of obligations of their job and putting more stress to the concepts of professionalism are visible among the physicians enrolled under managed care. Identifiably, there is a chance of communication gap persistent among the patients as well as the physicians (Feldman et al., 1998). Moreover, the overall development of the different concepts among the physician may increase lack of belief among the patients towards the physician. The lack of trust among the patients towards the physicians may also be noted as affecting the different needs of the managed healthcare system and its goal of providing quality care to the patients in turn. Furthermore, to generate more revenue, the physicians began disregarding the significance of the ethical considerations related with their professional roles. Hence, the patterns that are being followed under various needs of managed care must be reviewed to provide a clear picture of the overall system and enhance the quality of care giving. This would even help in developing the confidence among the patients to avail managed care and enhance their approach towards healthcare needs. Additionally, this would help in adding quality to the services provided through managed care systems. By developing a better interpersonal relationship, the managed care system will be able to ensure quality care to the patients and develop their approach towards availing extended services under the system of managed care (Feldman et al., 1998). Conclusion Notably, many physicians were of the belief that the managed care system was negatively affecting the quality care within the healthcare domain. By creating professionalism among the physicians, the healthcare units are negatively affecting the overall concepts of providing quality care. With the elated amount of professionalism, the ethical constraints of the physicians are noted to be affected that further led to a huge amount of miscommunication among the various units of the society. Correspondingly, the lack of proper care is in turn creating a perception that the different reforms brought into the managed care system are only having an impact on the fee based services under the domain. These perceptions are again going to create negative mentalities of the patients towards the concepts of managed care. Furthermore, this negative perception of the patients towards the concept of managed care is going to create adverse effect on the managed healthcare systems. References Feldman, D. S., Novack, D. H., & Gracely, E. (1998). Effects of Managed Care on Physician-Patient Relationships, Quality of Care, and the Ethical Practice of Medicine. Arch Intern Med. 158(15), 1626-1632. Lee, P. R., Estes, C. L., & Rodriguez, F. M. (2003). The nations health. USA: Jones & Bartlett Learning. Sekhri, N. K. (2000). Managed care: The US experience. Bulletin of the World Health Organization, 78(6), 830-844. Zimlichman, E., Mandel, D., Mimoumi, F. B., Vinker, S., Kochba, I., Kreiss, Y., & Lahad, A. (2005). The role of primary care physicians in Israel defense forces: A self-perception of the study. IMAJ, 7, 174-177. Read More