The researcher states that in the past several decades, the federal government has attempted to offer quality health care services to its citizens through health care programs. However, these programs have not been successful, as they had anticipated. …
Download file to see previous pages...
Center of discussion in this paper is managed health care as delivering health care in an integrated system and in an organized manner. The main goals of managed health care are to enhance the clinical quality of the medical services, to enhance the client and social service element of health care, and to minimize the costs of distributing quality health care. Managed care is a structured approach to purchasing and getting the right service for a particular health need. Health maintenance organizations (HMOs), preferred provider organizations (PPOs), and physician hospital organizations (PHOs) are forms of managed care. Managed care and in particular, the health maintenance organizations became popular as a way of enhancing care and minimizing unnecessary services. However, towards the end of 1990s, the consumer backlash resulted in the abandonment of the firmly controlled care management systems. Quality is “now the watchword for 21st century healthcare as the institutions and individuals who pay for services begin to focus on what they are getting for their money”. In other words, individuals demand for quality health care because they are paying for it. There is still no consensus as to who should be accountable for the provision and financing of the health care services in the United States. This has resulted in a patchwork system in which the individuals, employers, and the government all assist in covering up the expenses. For a while, the government has assumed the mandate of providing health insurance to particular deserving populations (such as some poor people, children, disabled, and other older persons) but it has generally shunned financing care for the working adults (Earp, French, and Gilkey, 2008). Instead, majority of the working adults get insurance either through buying coverage on their own or through their employers, or they go without the cover. It is important to note that there is no single unifying system offering the systems. The health services are offered directly by private providers, organizations supported by state or federal funding, and governmental organizations (like the public health). Health care services are provided by both not-for-profit and for-profit organizations (Earp, French, and Gilkey, 2008). Managed care imposes quality measurement, accountability, controls, and organization in the delivery of health care to attain the buyer’s aims for access to cost of care, effectiveness of care, care, and quality of care. The introduction and growth of managed care strategies have influenced the general health care organization. They have begun to alter the delivery of publicly and privately health care (National Research Council, 1997). Provider Contracting The aim of a managed care organization is to offer or organize for the health care services provision. Majority of the managed care organizations like the preferred provider organizations (PPOs) and the health maintenance organizations (HMOs) offer their services through agreements with medical groups, individual physicians, hospitals, individual practice associations (IPAs) and other kinds of health care facilities and
...Download file to see next pagesRead More
Cite this document
(“Managed health care future for the disabled and poor Essay”, n.d.)
Retrieved from https://studentshare.org/nursing/1394885-managed-health-care-future-for-the-disabled-and
(Managed Health Care Future for the Disabled and Poor Essay)
“Managed Health Care Future for the Disabled and Poor Essay”, n.d. https://studentshare.org/nursing/1394885-managed-health-care-future-for-the-disabled-and.
Barriers in this sense refer to the obstacles that delay and prevent target populations, especially the vulnerable groups such as the disabled, women, children, and the elderly from accessing, affording, and utilizing the much needed health services. In addition, barriers to health care also make these at-risk people get inferior health services compared to the advantaged sections of the population (Purnell & Paulanka, 2008).
Current paper focuses on the correlation between the policies related to managed care plans and the activities of managers in health services organizations. Emphasis is given on the issue whether these policies can influence the above-mentioned activities and at what level such interaction could be developed.
He/she is also called primary care physician (PCP). The PCP is usually required for the patients who select healthcare officers from the available managed care network plans of hospitals (Department of Health, 2013). Primarily, managed care is a healthcare procedure that covers cost-containment strategies, risk provision among insurance units, employers and providers, administration and reporting thereon.
Factors have included more convenient services, to be considered as equal partners in the healing process, to be able to choose local sites for services, and to feel supported by the National Health System (NHS) to be well, remain out of hospital and independent.
The new system was expected to ensure quality care and control over the escalating health care cost. There are various Managed Care models like HMO, PPO, POS, and FFS which offer financing, insurance, delivery and
include incentives for general physicians so that they choose such medical equipments which are of comparatively lower cost but of high effectiveness, sharing of costs for surgical instruments and proving maximum facilities in this regard. Although the above mentioned and some
racting party negotiates a discount with the provider, and then trades access to discounts to a nonrelated entity after the provider offers services to an individual covered by insurance policies of the nonrelated entity (Roberts, 2000).
Under the South Carolina law, an