Public Health And Managed Care: Annotated Bibliography

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

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 concept generates images of large healthcare entities managing the administrative protocols of prior authorization or denials to the actual delivery of care through a facility or network of healthcare providers. Hacker and Marmor (1999) described several meanings of the term managed care with the most applicable to the menagerie of forms managed care can take being a combination of the financing and delivery of healthcare services. While this particular study is dated, the authors contend any managed care structure features administrative oversight, patient steerage to a particular provider entity or network and the amount of risk-sharing whether at an individual or group level. These features continue to be true today as organizations explore the benefits offered to employees through managed care structures such as preferred provider organizations, clinically integrated networks, and accountable care organizations. As a healthcare provider, the goal is to provide access to healthcare which is affordable, offers access to providers of choice and engages with providers who provide the highest quality

The book discuss about three major types of managed care organization: health maintenance organizations (HMO), preferred provider organizations(PPO), and point of service plans(POS). Managed care has been around for minute. This organization has been around since 1930s. The three managed care organizations are require an agreement between the insurer and a network of health care providers. Policy holders are encouraged to use the providers in the network by the fact a percentage will pay the cost of care if received outside the network.

"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.

Managed care has been around since the twentieth century, which managed care has continued to develop. Therefore, the definitions of managed care may vary from different scholars and/or textbooks. As a result, one meaning of managed care is to provide health care services at a reduced rate to members of an insured group through an agreement among specific suppliers and an insurer (Ereflect, 2009). Furthermore, some relevant scenarios for the meaning of managed care are the ability to increase access to a variety of healthcare services, managing medical practice, curbing medical spending, and restricting physician entrepreneurialism (Rodwin, 2010). In addition, managed care has been used by the states and private entities to promote diverse goals (Rodwin, 2010). Therefore, the initial growth of managed care was partly

This writer does not believe Terri suffered a painful and agonizing death. By Michael removing her feeding tube Terri was allowed to die naturally. According to the American Journal of Managed Care, pain is not an expected part of the dying process. Additionally, federal guidelines regulate hospice and require hospice make every reasonable effort to assure patient's pain is well controlled. With proper management of medication, patients can be pain-free without hastening the dying process. Terri was admitted for hospice care so this writer is confident in stating Terri was kept comfort throughout her dying process. Also, Dr. Cheryl Arenelladoes, a writer for the American Hospice Foundation, states patients suffering from persistent vegetative

Managed Care is a complex healthcare system in which physicians, hospitals, and other healthcare professionals organize in an interrelated system of people and facilities that communicate with one another and work together as a unit, commonly referred to as a network. This network coordinates and arranges healthcare services and benefits for a specific group of individuals, referred as enrollees, for the purpose of managing cost, quality, and acess to healthcare. Managed care program may be provided in a variety of settings, such as Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Managed Care Organizations (MCOs) performs three functions: (1) set up the contracts and organization of the healthcare providers who furnish medical care to the enrollees, (2) establish the list of covered benefits tied to managed care rules, and (3) oversee the healthcare they provide. Managed care greatly influenced the practice of medicine and that the enactment of the Affordable Care Act greatly affects managed healthcare planss (Beik, 2014). This paper will examine the future of managed healthcare delivery system under the Affordable Care Act provision to expand Medicaid program.

The Frieden (2010) article suggests that in order to get long lasting results to resolve a health care matter, the intervention should include a variety of levels from the Health Impact pyramid. The bottom tiers of the pyramid tend to have the greatest impact. However, they are often harder to implement and can be controversial, at times (e.g. sugar tax). Therefore, by combining policies, from the changing the context tier and programs from the tops tiers this will help the community to understand reasoning behind policy change as well as receive the resources and support to change health behavior.

Managed care is a system that, in varying degrees, integrates the financing and delivery of medical care through contracts with selected physicians and hospitals that provide comprehensive healthcare services to enrolled members (Iglehart, 1994). It also helps to control costs by controlling the delivery of services. While all managed care organizations are slightly different in their version of managed care, three seminal tenets embody the philosophy of all healthcare that is managed (Navarro & Cahill).

Managed care integrates the delivery of health care and financing of health care. In managed care, insurance companies controls the cost, quality, and access of medical care to beneficiaries by limiting the reimbursement levels paid to providers,, by reducing utilization, or both (Beik, 2014, p. 116). There are different types of managed care. Some of the most common types of managed care are Preferred Provider Organization (PPO) and Health Maintenance Organizations. Managed care programs uses different interventions such as economic incentives for doctors and patients, increased cost sharing, controls on inpatient admission and length of stays, and so forth (Deom, Agoritsas, Bovier, & Perneger, 2010, p. 1). On the other hand, managed care tools such as gate keeping, health care networks, second opinion requirement, and pre approval requirement for expensive treatments or hospitalization has changed healthcare delivery on both the macro and micro levels. On the micro level, it greatly impacts the quality of care, cost, autonomy, and relations with patients. According to the research study, managed care greatly affects physicians. It reduces career satisfaction through its impact on doctors’ autonomy and the pressure caused by managed care may affect the doctor’s ability to provide high quality of medical care. (Deom, Agoritsas, Bovier, & Perneger, 2010, p. 7). Like for example, managed care contracting has a positive and negative impact on physicians and patients. The

The article examines on the United States experience of managed care where it describes on the new modes of payment and cost controlling measures. Implemented measures by managed care improve quality care offered to the patients. Author also investigates on the current impact of the managed care on the quality of health services. The article uses surveys and theory in reviewing how measures have affected the practices of physicians.

Managed care is and has been consider an effective approach to the quality of health care in America. There is a debate among health care professionals, government regulatory agencies, and the public on how best to reduce the ever escalating health care cost while delivering the best evidence based treatment methodology to our clients. However, with the recent implementation of the Affordable Health Care Act, many health care providers are presented with a daunting task of providing leading edge innovations to their patients within the regulatory restraints placed on them by this act. Also, the future trend of health care is more about accountability to the consumers through the utilization of the consumer driven health plans with emphasis on account Based Health Saving Plans and transparency. The major impact on the delivery of quality care will be that the Affordable Health Care Act and how it will affect how insurance payers implement cost containing restraints, adhere to governmental regulations, and while delivering the best evidence medicine to the clients they serve.

Health care is a huge necessity no matter where in the world you are. However, health care in the U.S. seems to be lagging behind in many factors, like cost, quality and efficiency, compared to a few other countries like Great Britain, Germany, Taiwan, and Switzerland. After comparing International health care and American health care reform before and after the Affordable care act, it is clear that no health care system has displayed perfection, and each one has a negative and a positive factor.

Managed care was established in order to manage health care cost, utilization, and quality (Kongstvedt, 2015). In managed care, health insurance is provided through HMO, PPO, and other types of managed care. It has the potential to reduced health care spending and improved the quality of care. However, despite of its success in improving the quality of care through preventive health care services, chronic disease management program, and so forth, many physicians are reluctant to be part of the managed care environment. Some of the reasons are the impact of managed care to physician’s income and autonomy. Under managed care, insurers have decreased the fees paid to physicians. There are different ways how managed care organizations control costs. One of this is through selective contracting with health care providers and hospitals to lower costs. In selective contracting, health care providers agreed to accept lower prices in exchanged for guaranteed volume of patients under managed care plan (Culyer, 2014). This paper will discuss more issues and trends in Managed Care Organizations such as the rise of Medicaid Managed Care spending, the new Medicaid Managed care Rule, and the collaboration of Managed Care Organizations and Accountable Care Organizations to reduce health care spending and improve efficiency of care.