Essay about Managed Care

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Managed Care

There are so many problems with our society’s health care. Everyone wants to find a

solution, but no one has been able to come up with one yet. Many different things have been

tried, but none have put a cease to the exorbitant costs, which most believe to be the main

problem. Out of everything tried, the most recent and popular system is known as managed care.

Managed care is the most common form of health insurance in the United States, and provides

more a cost efficient coverage than paying a fee-for-service charge. However, it is also a very

complicated system. Over the next few pages I am going to try and go over the main parts of the

managed care structure. In the end, I am going to
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Although the goals have not yet been met, managed care has

continued to grow throughout the past four decades. At the end of 1996, there were over 600

HMO’s in operation, enrolling around 65 million members, which is about 1/4 of the population

(Tufts 1998).

Before I get into the different types of managed care organizations, I am going to go over

some cost control methods in managed care. Managed care organizations are different methods

used to control utilization of services. Utilization management requires three things. First, you

have to have an expert evaluation of which services are medically necessary in a given case. This

ensures that unnecessary services are kept to a minimum. Secondly it requires a determination of

how those services can be provided most inexpensively, while maintaining a high level of

quality of care. It also requires a review of the process of care and changes in the patients

condition to revise the course of medical treatment if necessary. The methods that are most

commonly used for utilization monitoring and control are choice restriction, gatekeeping, case

management, utilization reviews, and practice profiling.

The first method I am going to talk about is choice restriction. Traditional health

insurance gave the insured open access to any provider. This led to an over use of services. Most

of the managed care plans have some sort of

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