Pros and Cons of Managed Care

Having access to quality healthcare is major part of one’s life however the cost of care has been on the rise over the past decades and continue to rise every day due to many situation such

A Health care system of any country is an important consideration for the purposes of the overall development. One of the most important and essential feature of the human body is the health and the systems. In the same manner, proper management is also necessary. Furthermore, all the countries of the world have few targets and achievements to be made. On the other hand, it should also be noted down that, economic development and social welfare the two most are the two important factors. Economic welfare is connected with the increase in the wealth of the people at large (Niles, 2011).

The idea is to create a government-run health care plan that would be an alternative to the private insurance plans offered under the Affordable Care Act, or provide a fallback in markets where insurers have been pulling out. A public option could also be a way to stabilize the exchanges because a government-run plan could be used to enroll the people with the most expensive medical conditions. The private insurers would be more enthusiastic about selling policies because they might have to worry less about losses. Public option is simply a public health insurance agency, typically a government-run agency that can compete with the private insurers. This is sort of a half-way point between single payer and the pre- ACA private market. Almost

In 2010 President Barack Obama signed the Affordable Care Act (ACA) into law. ACA is pivotal legislation that had rippling effects throughout the healthcare system. The Affordable Care Act was drafted with the sole intention of expanding healthcare access across the country. Under the ACA, Americans are now mandated to purchase health insurance or face a penalty. Americans without insurance are able to get coverage by purchasing through the insurance exchange or by qualifying for Medicaid. The poverty level was raised for Medicaid and new provisions allowed single men to also qualify. Anyone that does not qualify for Medicaid would need to purchase a plan on the insurance exchange and various subsidies are available based on income level.

The Affordable Care Act is a law that was enacted on the 23rd of March 2010. Regardless of the fact that it was put into place in 2010, there are still numerous aspects of the law being debated today. The law has several provisions that are expected to take effect between the year of 2010 and 2020 (Reid, 2012). Among the significant reforms in the law includes a clause prohibiting insurers from refusing people coverage due to some preexisting conditions. In addition, these companies should offer the same price for all clients who are in the same geographical location and are the same age. Another reform was that families that are in the poverty line should receive federal subsidies if they decide to buy insurance through an exchange. The government also created minimum standards for insurance policies. The government also established health insurance exchanges as platforms for comparison of different policies. The Affordable Care Act also has an individual mandate

The new law added to a per-existing hospital provider tax, which lawmakers love because it leverages federal matching funds that help pay for the state's Medicaid program. Critics objected to the increase because it added a new tax on health insurance.

meaningful perception, even when they are not proven to be true. Some republicans are going against it. Why are the Republicans against it? Republicans say they are imposing towards the Affordable Care Act because of further many costs on the business, that most republicans are describing it as a "job killer". 32 million were insured will have to buy health insurance or even have to face a fine and those who cannot afford it are going to be subsided by the government. The package also includes ban insurers from refusing to cover people with existing medical problems and charging women more. “It's estimated that 22 million would lose medical insurance if Obamacare were repealed.” (“Why is Obamacare so controversial? - BBC News”). The Pew Research

Managed care has been adopted into the government funded care organizations. Medicare managed care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and the decisions about paying for treatment are controlled by the managed care plan. The basic premise of managed care is that the member/patient agrees to receive care from only a specific doctors and hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care has been used since the mid 1990’s in order to provide healthcare to beneficiaries with serious or life long illnesses. Today, managed care has become a way for states to provide quality care to both Medicaid and Medicare patients.

"Compared to Medicare fee-for-service, managed care plans typically cover more services and impose lower out-of-pocket costs but is limited to the providers authorized by their plan" (Scanlon, 1998). The question of quality of care and services provided started to chink away at the armor of managed care.

One of the main issues today is repealing of Obamacare. For that reason, I researched about Affordable Care Act and found an BBC News article that points out the problems of Obamacare and compares it to Trumpcare.

At the moment, it is sad to say the health-care fight in the US is over. The Senate bill replacing the 44th presidents Affordable Care Act has unfortunately after two more Republican senators ended their support. that left a ruling party that doesn't have a majority. to top it off the Senate majority leader Mitch McConnell is threating to repeal Obamacare entirely. with a couple years delay so his party can settle a new bill, even though several Republicans oppose that too.

One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare

The United States has a unique system of healthcare delivery, it is complex and massive. Twenty-five years ago; American citizens had guaranteed insurance, meaning the patient could see any physician and the insurance companies and patients would share the cost. But today, 187.4 million Americans have private health insurance coverage (Medicaid, 2014). The subsystems of American health care delivery are Managed care, military, vulnerable populations and integrated delivery

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

The health care system does need to be able to be managed fairly financially. Unfortunately, the driving force will always be money in the health care field because it is so easy to obtain. Since there has been so many false claims by physicians and their patients, numerous laws and regulations have been established to put an end to it.