Health Care Reform Project, Part I

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Health Care Reform Project
Part One
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...
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