Understanding the Future of Managed Care
Saida Ali Holyfield
At one point, managed care was the viewed as a resourceful tool in efforts to help assist employee, physicians and hospitals with quality health care, while controlling the cost of medical care in the United States. Over the past 30 years, managed care has been in the limelight of health insurance, as a dictator of how it will pay for medical bills. There have been many factors playing a role with managed care over the years. For example, due to the slim selection of options that are available with physicians in rural areas, and limited physicians to choose from, does this compromise the quality of care of each member or does this cut off services for members that are critically ill? Managed care continues to affect not just members in the work force but also it affects disabled members, the elderly community, and young children covered under Medicaid. The struggles to find a solution to all the concerns as it related to Managed care would continue to be an ongoing concern. The future role of government regulations, including ERISA and HIPPA will continue to play a role as it relates to managed care, and the protection of the rights of employees. The cost containment of health care benefits and the high deductibles are an ongoing topic for discussion as to how it affects employees and their medical needs going unmet for the lack of revenue to pay for the deductibles. In this paper discussion related to concerns, evolving around managed care would be discussed. The future for managed care would be outlined in depth, and the need for managed care would be mentioned.
Managed Health Care Quality
The initial beginning of Managed Healthcare started in the United States with the purpose of improving the medical system. Since the beginning, which has been over 3 decades, research has indicated that the goals are being reached. In fact, most research indicates that during the twentieth century, that managed care has been a resource that has somewhat restrained the growth of health care costs by governing the delivery system (Morrissey, 1997).
In the beginning, the beginning impression began in the western part of the United States to mimic the employee model plans similar to the Kaiser Permanente. The Kaiser Permanente provides the opportunity for employment to doctors and any physicians and other supplementary medical staff directly. (Morrissey, 1997). As a result, of all the publicity of the managed care in the private sector of the world, allowed the public sector to embrace it in the public American economy. The enormous growth allowed for additional medical expenses for the senior citizens, which was fortified by the national administration to allow Medicare managed care choices during the 1970s and 80s (Milestone, 2008). Provider Contracting
During the time of the Presidency of the Clinton government, that is when the initial meetings were held to address the concerns of whom should be held liable for the healthcare plan. Over the years, this has been an ongoing topic to address throughout the years. As of 2011, this topic is still very controversial and a topic that is open for discussion on many different levels. The fact that in most cases the insurance company has the authority to make decisions concerning the medical well fair continues to be an open debate filled with controversy. Whether or not it is the right for the insurance company to dictate the future of a member that is paying for his/her medical affairs will continue to be an open discussion. The insurance views this decision as their liability, whereas the member views the ultimate decision a dictator of his/her medical affairs.
According to the Cigna Healthcare website, the final decision is usually in most cases dictated by the top medical professionals that have been appointed as the advisors and decision maker so to speak of the medical claims....
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