Significant Event in Health Care

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

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.

Since its establishment in 1965 we have seen Medicare change as people’s needs change however being a federal program these changes do have an incredible amount of lag time. One of the first major changes to Medicare occurred in 1972 when President Nixon signed the Social Security Amendments of 1972 which extended coverage to individuals under age 65 with long-term disabilities, expanded benefits to include some chiropractic services and speech and physical therapy. During this time we see the American public growing tired of the Vietnam Conflict and lack of support and care for those returning Marines and soldiers with severe disabilities. As the protests escalate and the peace initiatives fail a key piece of legislation is signed showing government support and a willingness to extend health care benefits to this growing and vocal population of veterans (The Vietnam War, 1999). Also included in this Amendment is the encouragement of the use of Health Maintenance Organizations, President Nixon’s administration caught in the scandal of Watergate and pending hearings appeased the left and proposed the HMO Act, which Congress passed in 1973 (Phillips, 2003).

The delivery of the U.S. healthcare system has changed drastically over the years from the inception of organized healthcare to today’s underdeveloped system. Prior to the 1920’s,

This article reviews the changes in policies and procedures over a 40 year period, regarding state and federal changes in health care. The article describes changes in

There has been discussion to have universal healthcare system similar to Medicare as a method to have a centralized monitoring system of cost. There have also been other systems tried beginning with HMOs in the 1970s in an effort to streamline access to necessary healthcare services by employing a gatekeeper to their access at the primary care levels. With patient dissatisfaction, PPOs were tried which circumvent the necessity of referrals (Hacker, 1998). Either of these models had substantial effect on healthcare outcomes while the cost of healthcare continued to skyrocket. The US spends more than any other country on healthcare but outcomes are not better (Blackstone, 2016). In 2010, under President Obama’s leadership, Affordable Care Act was passed and one of the promising features is the formation of accountable care

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.

The US healthcare team of professionals keeps on looking for ways of improving health services offered to citizens. In 1965, the Medicaid and Medicare Acts were enacted; President Barak Obama made regulatory changes in the same measure by passing the Affordable Care Act. The Affordable Care Act was signed into law on March 23, 2010, following an enactment by the the111th Congress of the

Prior to the year 1760 and now I can say that health care has evolved in the United States. My prior knowledge of health care is that it was a system of home care remedies with doctors with little training to our now complex technology and bureaucratic system. With the birth of medical insurance, technological advancement, and the professional utilization of doctors, it would be very ignorant not to say that health care has evolved from what it was to what it is now. Manage care has definitely become part of that evolution and has impacted it as well with allowing the healthcare system to becomes nothing much than a growing cooperation whose business is making a profit from healthcare, and not providing the quality, reasonable cost, and necessary medical care when

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

Less than a hundred years ago, in the late 1920’s and 30’s, almost 90% of Americans did not have health insurance (Fall of HMO’s 4). They used a variety of home remedies and when medical assistance was truly needed, they paid for it out of pocket, even incurring vast amounts of debt. This had been the case throughout history, and it changed due to an important factor, medical equipment. The industrial revolution finally caught up with the medical industry and the country saw a vast change in the scientific instruments used by physicians. These instruments required a lot of money to make and care for which caused prices to rise. Due to this massive problem, a committee was formed of health care professionals and after a 5 year study, the Committee on the Cost of Medical Care suggested that health insurance co-operatives start. These corporate medical practices became known as Health Maintenance Organizations (HMO’s) and preferred provider organizations (PPO’s), and up until the 1970’s, were an experiment to regions across the U.S. Factors that hindered health care included bullying of “money politics” from both sides of the isle as well as Presidential views and tactics as well. President Nixon first

The Managed Care System was introduced to control the cost for health services provided to individuals. Managed care controlled who the consumer would seek health services from, as well as the cost of the service provided. MCO’s became deep-seated when President Nixon signed the Health Maintenance Organization (HMO) Act in 1973. The first type of managed care used were HMO’s and the purpose was to keep healthcare costs within limits. Physicians of course were against the Act. This would now control the fees that the physician would charge for the services they provide to the individual. As Managed Care evolved and increased in the amount of managed care plans that became available over the years. Physicians preferred guaranteed income as oppose

In 1965, Congress created Medicare. Seniors were forced into the free-for-all of Medicare, personal responsibility was replaced by paternalism, and, predictably, unrestricted health care for older Americans lead to frenzy of spending by patients and doctors. Those who had clamored for Medicare argued that, since the state subsidizes seniors' medical care, the state ought to pay for everyone's health care. In an act of pragmatism, President Nixon proposed the HMO Act, which Congress passed in 1973. The law gave millions of dollars to HMOs, which, until then, had constituted a small portion of the market.

Health care costs and coverage are prime considerations in most everyone's life (Wasley, 1993) in the last seven decades. Workers weigh the costs of health coverage when changing jobs. The struggle between the patient and the doctor keeps getting tighter. In the meantime, costs keep increasing. Despite attempts at reforms, today's health care has not provided the targeted most cost-effective care. Rather, it incurs volumes of medical errors and waste. Before proceeding to address the situation more rationally, a keener review of the evolution of the industry in the US should be made to discover what has been making it sick and chaotic. At once, one can see how much regulation and government control and those from interest groups are behind and create the trouble (Wasley).

In 1973, Congress passed the Health Maintenance Organization Act, which encouraged rapid growth of Health Maintenance Organizations (HMOs), the first form of managed care. Managed care plans are widely credited with subduing medical cost inflation in the late 1980s by reducing unnecessary hospitalizations, forcing providers to discount their rates, and causing the health-care industry to become more efficient and competitive.