Fee for Service Care Versus Managed Care

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Some researchers feel that our society has unrealistically demanded the health care system to maximize quality while lowering the costs of health care services. That if we demand this change, there is no way we are realistically considering the cost of health care. I understand that everyone wants to receive the best therapy without paying a large amount of money. When you think about this idea, this plan would take time to execute. One of the cons of living in a country like the United States is that we citizens expect to have things right when we want them. I totally agree that we deserve the best services at the lowest prices. But how should we go about executing this plan? We will have to balance the plan between two approaches, the fee-for-service care and managed care. As well as their similarities and differences, these health care styles have their up and their downs. So to make the American people happy, we would have to find an intersection that could increase the quality given and the lower the cost being paid by the client. We, as citizens, should be entitled to these conditions because many people cannot afford these therapy sessions that are terribly needed. By finding this meeting ground, we will set the stage for a better health care system and possibly a healthier people.

Until the 1980s, mental health services were generally purchased under traditional fee-for-service approach. In this way, practitioners controlled both the supply and the demand sizes of service delivery (Cummings, 1995). The practitioners would determine what the client needed, how and when to treat them, and how long therapy would last. Individual practitioners billed insurance carriers on a fee-for-service basis, and there was little encouragement for practitioners to reduce costs by increasing their efficiency and effectiveness. The numbers of healthcare professionals entering the marketplace was large, so the general idea was that fees would plummet. Contrarily, the complete opposite has been the case, and the fees have risen. The costs were rapidly mounting, especially in inpatient care. This caused third-party payers to demand more effective costs and quality controls (Acuff et al., 1999). Under fee-for-service care, some therapists may operate from the idea, “the longer the better”. To think that this system is not abused would be naïve.

The solution to this ordeal was managed care. Managed care stressed time-limited interventions, cost-effective methods, and focused on preventive rather than curative strategies. This style was easy to sell to businesses because it offered a plan that would control the increasing costs of health care. When mental health professionals failed to control rising costs of health care services, it helped develop managed care (Karon, 1995). Only a small number of people can afford the fees for psychological services. As the nation changes from fee-for-service toward managed care, as well as quality and cost, there are other issues that grab attention. Managed care is driven by economics, like any other business. Invalid are health care professionals’ attitudes that the chase of profit has no place in the effective delivery of psychological services. Current managed practice is branded more by an interest in reducing costs than by quality of service (Davis & Meier, 2001). Managed mental health care has considerably affected the counseling profession.

The social environment that health care providers have to make trade-offs in between quality and costs could not be more aggressive. Ever since the 1940s, people have held on to the idea that costs should not play a role in decisions about medical treatments (Eddy, 1997). Today there is a solid distaste against clearly taking cost into consideration when choosing the appropriate use of a treatment. This unmentionable aspect places a major limit on how any type of system can trade off cost and quality. The cost taboo is the result of two especially...
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