University of Scranton
This paper examines the benefits and issues with managed care. The benefits include patients receiving preventative care, lower premiums, lower costs of prescriptions, fewer, unnecessary procedures, and less paper work. Some issues with managed care include limitation on doctors that patients can choose from, restricted coverage, the possibility of under treatment, and compromised privacy. Managed care effects nursing by causing significantly few jobs for registered nurses, more opportunities in non-acute health care settings, and more use of advanced practice nursing.
With the economy in shambles and the rising cost of health care, many people are turning to managed care programs for health care coverage. The number of patients participating in “discounted” managed care programs is presently at a shocking all-time high. Over 150 million people are currently enrolled in some kind of managed care program, which attributes to about 60 percent of the population (Bertrand, 1996-2007). The main purpose of managed care is to provide high quality care at an affordable low cost. Managed care programs are said to have the best of both worlds. However, it is hard to find an even balance between the two. With such drastic restraints on spending and cost, the question of whether or not the quality of care is up to par comes into play. What is Managed Care?
Managed care is a type of health care program provided by a corporation that both finances and delivers health care services of high quality at a low price by focusing on prevention, health promotion, and primary care (Huntington, Health care in Chaos: Will We Ever See Real Managed Care?, 1997). In these programs, groups of doctors, hospitals, and health care providers join together to provide affordable health insurance to the public (Cohen, 2008). Providing preventative care helps keep costs down for insurance companies because it lowers the chances of patients’ developing certain diseases and illnesses that would be more expensive to treat. Having a single primary care provider helps in cutting costs because the person receiving care pays a single doctor to manage a patient’s health care and treatment plan that best suits them.
In the beginning of the 19th century, various alternative healthcare arrangements began to pop up throughout the country (Tufts Managed Care Institute, 1998). These health care arrangements were made to provide workers of the lumber, mining, and railroad industries and their families with adequate health care (Tufts Managed Care Institute, 1998). In these contracts, the participants paid the doctors a set fee and in turn, were provided with essential health care for them and their families. The exact structures of these systems varied, but the basic foundations were the same. During World War II, Henry Kaiser took notice of one of these prepaid systems that was set up by Dr. Sidney Garfield in his shipyards and steel mills on the West Coast and decided that it should be made available to the general public (Tufts Managed Care Institute, 1998).
Interestingly enough, the American Medical Association was opposed to anyone having control over medical professionals and tried to do everything they could do to deter patients from the early types of managed care programs. Their methods worked up until the 1970s when the country could no longer afford the outrageous costs of healthcare (Tufts Managed Care Institute, 1998). Several small issues from the beginning evolved into greater problems that could no longer be avoided. With no cost containment people were running out of ways to pay for their healthcare. Services were not accessible to everyone. Many people were uninsured. The need for drastic reform developed. The government turned to managed care for a solution to the health care crisis (Chitty & Black, 2007).
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