Significant Health Care Event Linda B. Conner, RN, BSN HCS/531 October 13, 2014 Dale Mueller Significant Health Care Event
The health care system in the United States has been growing and changing for years and will continue to do so for years to come. The one constant in the Unite States health care system is change and evolution through evaluations of those changes. If there had not been unrest with the level and provisions of care in the early 1970s Managed Care may have never been introduced. President Nixon signed legislation in 1973 termed, Health Maintenance Organization (HMO) Act of 1973. This pivotal event in the health care system allowed for a change from the fee for service model to a comprehensive range of medical or health care services in a single organization. (Mueller, 1974) Although there had been prior prototypes, such as Kaiser Foundation health plan, this legislation was documentation of the governments support and the beginning of Managed Care. The impact of managed care is both historic and immutable, yet even today, with the early growth of consumer-driven healthcare, managed care continues to morph(Navarro et al, 2009).
Prior to the HMO Act of 1973 patients paid for every service that was rendered on an individual basis as the services was needed and provided. The concept behind the HMO Act of 1973 was to charge the consumer one set monthly or annual fee. This fee was pre-paid regardless of the need for services. The set fee covered basic services to be rendered as the enrollee needed them. During the development of the HMO Act of 1973 it was determined that an HMO would be defined as entities that provided basic health services to those who were enrolled for a set fee per month, additional services could then be provided, but they incurred an additional fee. (Mueller, 1974) The inclusion of that clause allows for HMOs to charge the enrollee fees beyond their monthly premium. In 1974 the concept of a 400 copay would not have been...
References: Mueller, Marjorie Smith. (March 1974). Social Security Bulletin. Notes and Briefs Report Health Maintenance Organization Act of 1973. Retrieved from HYPERLINK http//www.ssa.gov/policy/docs/ssb/v37n3/v37n3p35.pdf http//www.ssa.gov/policy/docs/ssb/v37n3/v37n3p35.pdf Navarro, R. Cahill, J. (2009). Managed Care Pharmacy Practice (Second edition), Jones and Bartlett Pages 1 to 15. Significant Health Care Event PAGE 1
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