Health Care Reform Project
May 23, 2011
Health Care Reform: Managed Care
In this country there are numerous concerns about health care economics. Several factors contribute to the increase of health care costs. One area of concern is the impact of managed care on health care finances. Managed care has been around since the early 1970s. The definition of managed care is a set of contractual and management methods implemented to manage the financing and delivery of health care services. Initial implementation of managed care was for health care cost saving (Getzen & Moore, 2007, p. 203, para. 1). Though Managed care initially addressed several health care finance issues, there are still problems with the current managed care system. Examining these issues, researching managed care, and possible solutions can enable health care providers and consumers to address and implement new solutions to the current managed care system. Managed Care
Managed care is a health care delivery system that in some way places the provider or a manager in the position of managing the utilization of health care by the consumer. The advantages of managed care from a consumer’s perspective are the predictable cost for health care, such as a copayment. In addition, managed care encourages consumers to use preventive care, such as screenings and immunizations. The disadvantages with many managed care plan is the consumer most choose an affiliated physician, the need for prior authorization before hospitalization, surgery, and specialty care, and the out-of-pocket cost to the consumer if treatment is outside the network of physicians. Consequently “Because the managed care organization (MCO) takes financial responsibility for medical care, it has an incentive to provide care efficiently. To remain viable, it must compete on the basis of both quality and cost” (Getzen & Moore, 2007, p. 204).
Managed Care Regulations in the States
The article, “Managed Care Regulation in the States: The Impact on Physicians’ Practices and Clinical Autonomy,” reports the results of an analysis of the impact of managed care systems on the way physicians can practice. Competition of the analysis was done by combining information from state laws and survey responses. The impact of managed care regulations was assessed by comparing the differences in a physician’s clinical autonomy and practice experience in states that have adopted managed care regulations and states without these regulations; along with the impact of regulations on certain providers based upon the level of involvement by managed care systems. The results of the study showed that unregulated states displayed a decrease in physician autonomy because of managed care; physicians who had a high level of managed care involvement reported lower levels of clinical autonomy, quality of interactions, and ability to obtain services when compared to physicians who had limited involvement of managed care systems (Kronebusch, Schlesinger, & Thomas, 2009). What Doctors Think
The article, “What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients;” takes an in-depth look and assesses how doctors feel about the impact of managed care about factors such as quality of care patients receive, the control of health care costs, professional autonomy, and the doctors relationship with patients. Conduction of this assessment is done with a mail in survey of all active physicians who practice in clinical care, work at public hospitals/private hospitals, and have been board certification or are still training. Participants were asked to rate the impact of eight managed care tools on four aspects of care on a five level scale, five as very positive and one as very negative. A mean score from the four aspects of care was gathered upon completion. The eight managed care tools used in this study were “guidelines”: patients access to...
References: Agoritsas, T., Bovier, P. A., Deom, M., and Perneger, T.V. (2010). What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients. Health Service Research, Retrieved from http://www.biomedcentral.com/1472-6963/10/331
Goodman, J. C. (2011). Solving the Problems of Managed Care. National Center for Policy
Analysis. Retrieved from http://www.ncpa.org/pub/ba254
Getzen, T. Moore, J. (2007). Wiley Pathways Health Care Economics (1st ed.). John Wiley & Sons.
Kronebusch, K., Schlesinger, M., and Thomas, T. (2009). Managed Care Regulation in the States: The Impact on Physicians’ Practices and Clinical Autonomy. Journal of Health Politics, Policy and Law, 34(2).
Rodwin, M. (2010). The Metamorphosis of Managed Care: Implications for Health Reform Internationally. Journal of Law, Medicine & Ethics, 38(2), 352-364. doi:10.1111/j.1748-720X.2010.00494.x
Singer, D. (1997). The solution to managed care. Chiropractic Journal, 11(9), 47. Retrieved from EBSCOhost.
U.S. Department of Health and Human Services. (2011). Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs by Fixing Our Medical Liability
System. Retrieved from http://aspe.hhs.gov/daltcp/reports/litrefm.htm
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