Does Managed Care Work For Medicare - Term Paper Example

But for those who rely on Medicare for their health insurance benefits, those who are blind, disabled, over the age of 65 (Michigan in Brief: Healthcare Costs and Managed Care, 2002), it will soon be a thing of the past.

The solution that is being proposed in order to control the rising costs of Medicare is Managed Care. This is a controversial and questionable move due to the huge difference in the way that Medicare and Managed Care handle their members. Managed Care is described as a program that (The Basics of Managed Care, 1994)

1. Refers, in general, to efforts to coordinate, rationalize, and channel the use of services to achieve desired access, service, and outcomes while controlling costs.
2. Risk-based managed care describes care from organizations that provide or contract to provide health care in broad/specified areas for a defined population for a fixed, prepaid price [where the managed care organizations (MCOs) are at financial risk to deliver the services for the fixed price]. Managed care organizations use various strategies to control costs. "

Managed Care in theory sounds like a good thing. However, looking deeper into the way the program works shows that it will only increase the cost of healthcare for most senior citizens because the program concentrates on preventive services and patient education in order to cut costs. There lies the problem with Managed Healthcare. How exactly do the proponents of this program expect this program to cut Medicare costs when it only rewards the patient for being and remaining healthy? There is no senior citizen on this planet who does not need some sort of current medical care for a preexisting or currently existing condition. So how exactly can this particular program cut the costs of Medicare for senior patients?

The simple answer is that it can't. Medicare is necessary for retired citizens who cannot afford to pay for regular insurance coverage. They are of that age wherein illness is a common part of their lives and finding solutions or palliative care is already a norm, not an exemption. Once Medicare for the patient is placed under a Managed Care program, then Medicare will start to discourage people from seeking medical care unless it is absolutely necessary. But who is to say what is medically necessary for a patient and what is not? Senior citizens are understood to no longer be in the pink of health. They need medical attention most of the time. They may be willing to keep themselves healthy but their body may just not be able to cope. Managed Care will instead punish them for being sickly. These people will be limited to packaged medical services that may or may not cover their medical needs. Whatever happens, there will be a severe cost out of pocket for the patient. (Basics of Managed Care, 1994).

According to Dr. Dudley Adams (2001), there is this preconceived notion that since Managed Care prepays for healthcare, then the quality of healthcare would improve. Mainly because services would concentrate more on preventing illness rather than treating it. However, there is no solid evidence that such a move would actually benefit Medicare patients who may already be under some sort of medical care at the time that their Managed Care coverage takes effect. 

A closer look at the healthcare system in place for older Americans shows that the system is more fragmented than ever before. There is also a loss of the actual mission and vision of Medicare. Medicare was set up with the mandate to help out senior citizens and retirees, or those with acute illnesses with their medical coverage and bills. A direct contradiction of the basis upon which Managed Care functions. (U.S. Department of Health and Human Services: Agency for Healthcare Research and Quality, 2011)

The reality of the situation is that Managed Care does not reduce the medical needs of a Medicare member. An HMO may actually reduce the number of days a patient remains in a hospital by 16.8 %, but the rate of hospital admission for a Medicare/Managed Care member remains high. The system also reduces the kind of patient care and medical facilities that a Medicare/Managed Care patient can use while in confinement. Obviously, this is their way of keeping down healthcare costs. It may be the wrong way to cut costs, but that is what they choose to do and the patients are helpless to do anything about it. (Brown, Bergeron, Clement, Hill, Retchin, 1993).

It would really seem that turning over Medicare to a Managed Care office will benefit only the government and HMO. The government saves money and the HMO, earns money. The member/patient, however, is left holding the bag and suffering the medical consequences of the government's misguided cost-controlling efforts. This is not the solution to lowering the cost of medical care for Medicare patients. Instead, it is a death sentence.