Health Care System Is Unfair

The types of managed care are differentiated by definition, operation, structure, and information needs. `HMOs were the most common type of MCO until commercial insurance companies developed PPOs to compete with HMOs' (Douglas, 2003, p.331). `HMOs are business entities that either arrange for or provide health services to an enrolled population after prepayment of a fixed sum of money, called a premium' (Peden, 1998, p.78). There are three characteristics that an HMO must have. The first is a health care financing and delivery system that provides services for members in a particular geographic area. Second, is ensured access to a complete range of health care services, health maintenance, treatment, and routine checkups. Last, health care must be obtained from voluntary personnel that participate in the HMO. The five HMO models related to the participating physicians are the Staff

Furthermore, the United States spends nearly double the average $3,923 for the 15 countries ("Health Care Cost," 2011).” Accordingly the U.S. throws away more money than any other country on healthcare which consequently could jeopardize the medical attention that is being provided.

has the world’s most expensive healthcare system, yet one-sixth of Americans are uninsured. Approximately one-third (31%) of adults and a little more than one-half (54%) of children do not have a primary care doctor. Federal spending on healthcare in 2005 alone totaled $600 billion, a massive one-quarter of the federal budget. Someone files for bankruptcy every 30 seconds in the U.S of health concerns. And every 1.5 million families lose their homes to foreclosure due to unaffordable medical costs. The U.S. spends six times more per capita on the administration of the health insurance system than Western European nations, who insure all citizens.“ www.realtruth.org/articles/090203-005-health.html. “In United States, the annual cost of health care per capita is $5,711. http://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/#ixzz12f0I1lbk

Many people believe that the current of health care in the United States is the best health care in the world however it has major shortcomings that has become more visible for the whole world to see. The United States has the most expensive health care system in the world based on health expenditure per capita and on

While our understanding has evolved with respect to certain advantages of MCO’s, our understanding of the disadvantages has also grown. This analysis will evaluate the use of MCO’s as a gatekeeper to controlling health care cost and offerings. It will evaluate the advantage MCO’s provide in a rapidly growing market due to the aging of baby boomers. The analysis will evaluate disadvantages that can arise with relying on MCO’s. These disadvantages work against the insurance company forcing a polarizing balance between how much control the MCO should retain over recommendation and provision of services.

Health care spending in the United States of America as a percentage of the economy has reached astonishing heights, equating to 17.7 percent. This number is shocking when compared to other counties; in Australia health care is 8.9 percent, in United Kingdom 9.4 percent, in Canada 11.2 percent. If the American health care system were to hypothetically become its own economy, it would be the fifth-largest in the world. While these statistics sound troubling, they lead us to look for answers about the problems surrounding our system. The first health insurance company was created in the 1930s to give all American families an equal opportunity for hospital care and eventually led to a nationwide economic and social controversy that erupted in the 1990s and continued to be shaped by the government, insurance companies, doctors, and American citizens. In this paper, I will go in to detail about the various opinions regarding the controversy, the history behind health insurance companies, and the main dilemmas brought out by the health care crisis. Greedy insurance companies combined with high costs of doctor visits and pharmaceutical drugs or the inefficient hospitals all over America can only describe the beginning to this in depth crisis. Recently, the United States health care industry has become know for the outrageous costs of insurance models, developments of various social and health services programs, and the frequent changes in medicinal technology.

The U.S. health care system faces challenges that indicate that the people urgently need to be reform. Attention has rightly focused on the approximately 46 million Americans who are uninsured, and on the many insured Americans who face rapid increases in premiums and out-of-pocket costs. As Congress and the Obama administration consider ways to invest new funds to reduce the number of Americans without insurance coverage, we must simultaneously address shortfalls in the quality and efficiency of care that lead to higher costs and to poor health outcomes. To do otherwise casts doubt on the feasibility and sustainability of coverage expansions and also ensures that our current health care system will continue to have large gaps even for those with access to insurance coverage.

Health System Reform in the United States: Impact of Rising Premiums and Opportunities for System Improvements to Enhance Access to Healthcare Services

Another type of managed care program that was introduced is the Preferred Provider Organization (PPO). A PPO is comprised of a group of physicians, hospitals and other medical service providers who contract with employers, insurance companies or other plan sponsors. The PPO offers discounted pricing to these contracted organizations due to the high volume of business received. PPO’s typically have up-front cost sharing in the form of deductibles and/or co-insurance, which vary depending upon the actual plan chosen.

HMOs are usually the least expensive health plans, offer predictable costs for health care, the least administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, & Raffel, 2010). However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring patients to see a provider in the HMO network, and often not covering more costly procedures or care options, because care is managed to control excessive or unnecessary care. Providers gain if they provide less care (Austin & Wetle, 2012). This incentive could affect patient-provider trust.

Patients could be attracted to Staff Model HMOs for a variety of reasons as well; because Staff Model HMOs are practiced in comprehensive medical facilities, all necessary resources are located in one place. Unlike the Group Model, new physicians would be salaried and would therefore not feel the pressure to “push,” patients

T.R. Reid uses cost, quality, and choice to fully evaluate healthcare systems all around the world. As an American citizen, I have always thought our system was unfair. The poor suffer more than the rich for going to see a doctor for the same reason. In chapter one of The healing of America, T.R. Reid comments on how many Americans have also started to notice that the American healthcare system is not as great as we once thought. Not only is it unfair, but it is also expensive and unsuccessful (9). By looking at all the other countries’ healthcare systems, Reid would then be able to better pinpoint how America can better its health care system by taking portions of those health systems.

When evaluating a provider's location for accessibility, managed care organizations consider the distance between the provider's location and members, as well as geographical barriers. It is not the intent of a managed care organizations to expend long trips to physicians or hospitals for medical care. For each provider type, the organization also examines typical patterns of utilization and average costs for selected services. Baker comments, "Defining a panel offers managed care plans the advantage of selecting providers with whom they are interested in working as well as the potential to obtain some contracting advantages through which they can sometimes obtain discounts from physicians who would like to be included in the panel" (Baker, 2000, p.3).

New England Health Maintenance Organization (HMO) is a regional not for profit managed care company that has its headquarters in Boston, MA, with over 500,000 enrollees within 25 different plans including Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. A consortium of employers has shown interest in bidding on a managed care contract to be offered to the consortium’s 75,000 employees whom are locate in and around Nashua, New Hampshire. The consortium of employers includes companies such as IBM, Ford, and Prudential Insurance.

Critics believe that the present functioning of managed-care is degenerative to health care. Managed-care firms control costs by requiring patients to use a “network” of approved doctors and hospitals, and by reviewing the actions of doctors. Patients have to pay more to visit a doctor who does not participate in the “network.” Managed-care firms second-guess doctors, considering only the costs. Patients are often prevented from visiting specialists to reduce costs. A managed-care company might insist that its doctors prescribe inexpensive generic drugs instead of commercial products. Many patients must, also, receive the insurer’s approval before undergoing treatments or operations. HMOs have been criticized for refusing to pay when a patient goes