Managed care in the United States will constantly be changing or evolving. This is due to advances in technology, improvements made by the providers and deliverers of the services, new federal and state laws, and a shift towards a performance based system. Managed care will be delivered to the consumer in an affordable, innovative, and reliable manner with an emphasis on quality and accessibility.
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.
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,
The paper will discuss the evolution of health care in America and how it has affected the health care system today. It will discuss the advancements made in technology and medical services that have evolved over two centuries. It will review how health care delivery has evolved and impacted today’s health system. The delivery of medical services has changed over many decades. The culture, social economics, and political views, have influenced society on how the medical services and advancements in medical technology have evolved. The three phases of health care structural change is preindustrial era, postindustrial era, corporate era (Shi & Singh, 2013).
Managed care was born out of necessity. It involves plans, members, providers, and payments intertwined, one not working without the other. With managed care came rising health care costs. Utilization management and quality initiatives were introduced to help control these costs. Medicare and Medicaid were also helpful in setting standards of care which reimbursement is based on as well as providing access to health care for more people. Health care costs continue to rise but with passage of the Patient Protection and Affordable Care Act (ACA) the goal is more people will have access to affordable, quality health insurance while reducing the growth in our healthcare spending.
1929: First offering of prepaid hospital insurance to members of a teachers union in Texas. Offering insurance for the employed effectively screened out unhealthy people and kept the risk low. Primary goal was to provide a steady flow of income to hospitals during the Great Depression, when hospital revenue dropped.
of the patient with controlling the costs of care, the issue of the uninsured began to grow. The concept of some sort of governmentally funded universal health care for all began over a century ago, however, never successfully implemented. From a historical viewpoint, individuals obtained health insurance by purchasing their own policy, as a benefit of employment, or through governmentally funded programs that required certain eligibility criteria be met in order to be eligible. If a person did not qualify for one of these types of health insurance, they generally were left without health insurance coverage.
Managed care is a system of healthcare delivery that seeks to achieve efficiency by interpreting the basic functions of healthcare delivery. It employs mechanisms to control (manage) utilization of medical services and determines the price at which the services are purchased and how much the providers get paid.
The idea of prepaid health care dates back to the beginning of the 20th century. The first HMOs were started in the 1920s in Elk City, Oklahoma
Health care has been inclined by several significant events that have occurred throughout history. Change is the primary focus on what has shaped health care and continues to by pain of improvement, and to focus on the importance of our population and their needs. Though there are several influences politics, finance, culture, technology, health trends, and religions they all play a major contribution towards shaping the healthcare field. (Shi & Singh, 2012) Throughout this paper we will present significant events that have changed and affected health care today, give details about how the historical evolution of health care
To attract Medicare patients, hospital must be contracted with Medicare. Hospital must also be contracted with private health insurance companies that provide Medicare Part A or Part B benefits. As per Kaiser Family Foundation, there are more than 55.5 million Medicare beneficiaries in the U.S. and Texas has more than 3 million. Hospital should have regular contact with senior citizens and can be made attractive to Medicare patients by offering sessions about healthy life style choices. Also offer regular disease management sessions, exercise group and organize social activities such as trips to mall, museums. Seniors should also be encouraged to take tour of the hospital.
In the past, managed care in the United States took the form of voluntary programs. Such programs date from about 1850, when managed care was provided chiefly by cooperative mutual benefit and fraternal beneficiary associations. Limited coverage by commercial companies was also introduced during that period, and subsequently many plans were established by industries and labor unions.
rising health care costs. Managed care can be defined a system of delivering health services in