Essay about Health Care Systems

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

Physicians were looking for assistance with HMO and PPO insurance companies and rising healthcare cost and PhyCor, Inc. was there to provide the administrative management. PhyCor, Inc. is considered a physician practice management firm, or PPM, that bought out other management firms to become one of the largest firm due to their ability to negotiate managed care contracts. What attracted physicians to PPMs was their ability to “lower cost and increase revenues” (Burns, L.R., Bradley, E.H., & Weiner, B.J., 2011). PhyCor, Inc. was able to merge large physician groups and specialty clinics creating revenue in the millions, and continued to grow. They grew for several years before the values in stock starting falling, unsatisfied physicians, and

People are aware that managed care has caused patient free will to be lost in the sprint to cut price. Insurance companies in this sense control patients rather than self-monitoring or by a physician. One wants to make their choices. Managed care -whether in the form of HMOs, PPOs, etc., or limits on service- is an attempt by the payers (insurance companies, federal agencies or self-funded groups) to restrict payment for services and procedures the payers consider to be unnecessary

The short term decision to start in a limited area and then only grow by one state in 2015 may have served the purpose of limiting risk during a time of uncertainty, however, in the long term, penetrating into new markets may be difficult because individuals currently enrolled are automatically re-enrolled at the end of the period. For Aetna, it may be harder to pull a member from a plan that they currently have. The largest healthcare insurance company UnitedHealth was more conservative than Aetna in the first two years, with participating starting in five states in year one then increasing to 24 in year two. With the addition of UnitedHealth in the same markets as Aetna and the unknown risks associated with new enrollees for the 2015 plan year, the short term could be crucial for Aetna. If Aetna is able to add to 2014’s positive results, and increase membership in markets that UnitedHealth entered, it will go a long way toward their long term goals of increasing membership in the individual and small group sector (Demko, 2014).

High concentration in the market, as we all know, leads to market inefficiency, where insurers are able to set inadequate or unfairly discriminatory premium rates. Few oligopoly firms operating in the statewide markets are definitely to use market power for their advantages. These can be tightening barriers to entry what some of the US health insurers have been doing. For instance, large insurance companies like UnitedHealth Group, WellPoint and Aetna have been acquiring existing smaller health insurers without developing their own networks and products. These acquisitions tend to decrease competition and thus making insurance market more concentrated. On the other hand, there are more of the few ways of getting rid of competitors, one of them being through cost-efficiency. As far as Choi and Weiss (2005) concerned, cost-efficient firms are able to minimize cost and thus charge lower prices than competitors, which

Regulations that prevent insurance companies from participating in interstate commerce have caused competition to grow stagnant in the United States. This lack of competition has allowed the adoption of wasteful procedures by healthcare providers, which in turn passes the increased expenses back to the insurance companies. Therein, insurance costs increase, crippling consumer’s cash flow and quality of life. While healthcare costs continue to rise, people must scrutinize the current healthcare system.

Managed care and its competition is being viewed to solve their issue on the struggle to control

The health care system in the United States has been growing and changing for years and will continue to do so for years to come. The one constant in the Unite States health care system is change and evolution through evaluations of those changes. If there had not been unrest with the level and provisions of care in the early 1970s Managed Care may have never been introduced. President Nixon signed legislation in 1973 termed, Health Maintenance Organization (HMO) Act of 1973. This pivotal event in the health care system allowed for a change from the fee for service model to a comprehensive range of medical or health

The dissatisfaction with managed care for some consumers has resulted in the change of some insurance plans altogether. "Significant numbers of health plans have reduced their reliance on managed care tools at a time when health insurance premiums have returned to double digit rates of growth in many markets. Faced with fewer instruments for curbing utilization and constraining provider payments, health plans have attempted to mitigate premium growth by shifting costs to consumers. These developments promise to lighten the administrative and financial burdens that managed care has imposes on physicians and hospitals, while leading consumers to

The health insurance market in the United States has been anything but competitive since the dawn of it 's existence. In many states, a single health insurance provider dominates the market, with virtually no competition (Holahan and Blumberg). In the past, before 2010, there has been no “marketplace” to compare prices for health insurance, which has contributed to ignorance in terms of finding competitive, lower prices for health insurance. Essentially, health insurance providers have been “price makers” rather than “price takers” because the demand for health insurance is relatively inelastic (as people will always get sick or get

In other economic areas, competition improves quality and efficiency, stimulates innovation, and reduces costs. Health care should be no exception. If there were more insurance company competitions, the insurance companies will decrease their premium and increase their quality, because they want more employers and individuals to buy their health insurance. Employers can compare the different insurance products, and choose the better one. The insurance premium would not create a stress on employees’ wages and providers can get better payments. Providers will be able to work with insurance companies to create price competition to lower the prices based on customer services, quality, data analysis and

HMOs multiplied rapidly with the new federal giveaways. Managed care, now including PPOs, mushroomed. Employers initially perceived managed care plans as cheaper than traditional fee-for-service insurance. Gradually, they stopped offering a choice of health plans, making individual policies more expensive. HMOs' penetration of the industry had been subsidized into existence. Government had instituted managed care. Today, while overall quality of patient care remains the best in the world, doctors practice medicine in an increasingly intricate web of rationing and regulations: Physicians are stripped of professional autonomy. As patients wander the maze of managed bureaucracy, costs rise and quality deteriorates. Every American dependent on a third party for health coverage is a potential victim of managed care. And state sponsored management of medicine

One of the trends now in Managed Care is the significant increase of federal spending for Medicaid Managed Care. According to

A competitive market is one that allows easy entry and exit: a market in which companies are generally free to enter or to leave at will. This does not describe the health care market in the US. There are certain assumptions that the competitive market model operates under some assumptions, first is the consumer/patient has full information about the nature of the services required, the anticipated results of their decision and the benefits obtain from the service. This is not true in health care often time the patient is operating at a distinct information disadvantage when they require health care services such as insurance. If a patient purchases health insurance often they don’t know enough information to ascertain if they have

It is said that a healthy nation is a wealthy nation. Healthcare is an important concern for every government as people get ill, accidents happen, emergencies arise and the health institutions are needed to diagnose, manage and treat the different types of ailments or diseases that may arise. The healthcare industry is divided into several areas in order to meet the health needs of anyone and everyone. All over the world, the healthcare structures are different to accommodate specific needs of the people in that demographic however the healthcare methodology in Third World Countries does not accommodate the needs of their respective inhabitants in comparison to First world Countries. The Rate of corruption, quality of healthcare institutions, lack of adequate, functional surveillance systems and problematic hygiene conditions are amongst the top reasons why the healthcare systems in third world countries are substandard in comparison to First world nations.