Pros and Cons of Healthcare

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

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.

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

Throughout the last half of the 20th century, employers have acted on their own to regulate health costs by requiring employees to join health maintenance organizations (HMOs). More than 100 million Americans are under managed care. However, many patients and doctors complain that HMOs impose too many regulations and sacrifice healthcare quality. HMOs are undergoing a high level of scrutiny due to criticisms that the network is controlling and jeopardizing the healthcare system of the nation.

Under the HMO, each patient is appointed to a primary care physician (PCP), who is essentially accountable for the long-term care of the members that she/he has been assigned and any specialists that a patient needs to see should be referred by their PCP. Some examples of HMOs are Kaiser Permanente and Humana. HMOs have been licensed at the state level, under a license that is known as a certificate of authority. A pro of an HMO is that treatment for a patient can begin prior to their insurance being authorized; A member may benefit from this because there would be little to no treatment delays. A con of an HMO is that in order to save cost, most HMOs provide narrow provider networks; A member may not benefit if in an emergency because their “in-network” emergency room might be far or there are “quick-care” in their area.

Through the use of managed care, HMOs and PPOs are able to reduce the costs of hospitals and physicians. Managed care is a set of incentives and disincentives for physicians to limit what the HMOs and PPOs consider

In an attempt to understand the impact of managed care in the U.S, I look at the most commonly expressed complaints against the organization. In a survey of consumers, 60% said that managed care had not made a difference in health care cost or had actually been the cause of the increase of health care cost. Managed care has had an impact on slowing the rates of growth in the costs of two major health care producers: hospitals and physicians. Little evidence has suggested that the current reimbursement are inadequate to the care provided. The quality of care is a highly debated issue. Physicians are concerned that the quality of care in managed care organizations may reflect the loss of professional autonomy through pre-authorization procedures.

6). We are able to see how these significant events impact us even now. As our health care system continued to evolve, the 1990s saw health care delivery and financing primarily controlled by indemnity insurers, nonprofit hospitals and private physicians (Gabel, 1997, p. 134). Health insurance premiums grew by 20% and enrollment grew from 36.5 million to 58.2 million (Gabel, 1997, p. 134). With the growth of managed care plans, hospitals began to merge and the development of large physicians group practices evolved (Kongstvedt, 2016, p. 14). These roots of managed care grew to give us the health care system we are familiar with now.

Throughout the modern era of the United States, one constant issue in society is free healthcare. This issue is not just an issue in the United States, but also in the whole world. Many other countries have made drastic changes in order to fix or at least attempt to fix this issue in their own country, but the U.S. has not done very much. Many Americans believe that free healthcare is something that tax paying citizens should be entitled to. These citizens of the United States ask why and how do many other countries have free healthcare, but the U.S. does not. These citizens ask this because they consider the fact that the United States is a very powerful country, but there are many other poorer countries around the world that have free healthcare.

(POS). There are over half of Americans with health insurance are enrolled in managed care

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 United States healthcare system has been the topic of much debate lately, with many propositions and reforms introduced to the public to remedy the many complaints made against the current system. The U.S. spend entirely too much money on health care. Based on data released by the World Health Organization (WHO), the "U.S. spent more on health care per capita ($4, 849) and more than 17 percent of its gross domestic product (GDP) to health care" (Squires, 2012).

“Managed care embodies an effort by employers, the insurance industry, and some elements of the medical profession to establish priorities and decide who gets what from the health care system.” (JAMA.2001; pg. 285:2622-2628). Manage Care is part of the Health Care system since 1973 is known as the system that finances and delivers health care to individuals enrolled under their plans. Manage care is intended to reduce the unnecessary health care cost in America through a variety of mechanism that includes medical necessity review programs, economic incentives for physicians, beneficiary cost sharing, control of

The managed health care system is a complex process that must align financial incentives and goals. Therefore, managed care is thought of as a complex puzzle that once one piece is moved it will affect the outcomes of the rest of the system (Boyd & Finamn, 2010). As a result, it is essential that the managed care organization have the ability to align its financial incentives with the goals of all parties involved, such as the providers who deliver healthcare services and the health insurance plan with its benefits. The purpose of this paper is to assess the history of managed care.

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