The Problem Of Health Care

Regulations that prevent insurance companies from participating in interstate commerce have caused competition to grow stagnant in the United States. This lack of competition has allowed the adoption of wasteful procedures by healthcare providers, which in turn passes the increased expenses back to the insurance companies. Therein, insurance costs increase, crippling consumer’s cash flow and quality of life. While healthcare costs continue to rise, people must scrutinize the current healthcare system.

Health care cost has risen dramatically in the last decade. Health care plans have been forced to look at the quality of health care given by the providers so they can implement certain strategies to help reduce heath care costs. Managed Care describes a group of strategies that is looking to reducing the costs of health care for health insurance companies. (Kongstvedt 2007)

At one point, managed care was the viewed as a resourceful tool in efforts to help assist employee, physicians and hospitals with quality health care, while controlling the cost of medical care in the United States. Over the past 30 years, managed care has been in the limelight of health insurance, as a dictator of how it will pay for medical bills. There have been many factors playing a role with managed care over the years. For example, due to the slim selection of options that are available with physicians in rural areas, and limited physicians to choose from, does this compromise the quality of care of each member or does this cut off services for members

In this country there are numerous concerns about health care economics. Several factors contribute to the increase of health care costs. One area of concern is the impact of managed care on health care finances. Managed care has been around since the early 1970s. The definition of managed care is a set of contractual and management methods implemented to manage the financing and delivery of health care services. Initial implementation of managed care was for health care cost saving (Getzen & Moore, 2007, p. 203, para. 1). Though Managed care initially addressed several health care finance issues, there are still problems with the current

Within the capitalistic economic structure that defines American commerce, the delivery of healthcare has largely shifted from an emphasis on public service to the pursuit of commoditized profit generation, but because good health is unlike any other product on the market the evolution of healthcare economics has been muddled by the advent of managed care. While the law of supply and demand reigns supreme in the exchange of traditional goods and services, emergency surgical procedures, prescription medications, and in-patient care are all provided through a relatively competition-free environment. The traditional model in which a Primary Care Physician (PCP) served the vast majority of his or her local community, providing the full spectrum of basic healthcare services from the delivery of infants to annual immunizations, precluded consumers from exercising that fundamental right guaranteed by capitalism: the ability to shop for the best deal. Despite the high costs associated with the microeconomics of the PCP model, Americans largely tolerated the proverbial monopolization of healthcare delivery because they invested a tremendous amount of trust in their PCPs, who in many small- to medium-sized towns developed lifelong relationships with patients, assisting their births, providing pediatric care, administering adult physical examinations, and even providing convalescent and end-of-life care to members of their community.

Managed care and its competition is being viewed to solve their issue on the struggle to control

A major change is occurring in the healthcare system as the United States continues to move toward enhancing patient care quality and access while also decreasing cost. This significant transformation is driven by a variety of forces, including changes in managed care, a shift from pay for service to pay for quality, and ever-evolving client characteristics. This paper aims to discuss each of these factors and the ways in which they make this major transformation a difficult one for the nation to undergo.

Managed care has turned into the name for a change in the way health care is organized and financed in the US. Now a day the health care system is not just difficult, it is essentially unique in relation to what it used to be. The progressions are numerous and speak to the real moves required in moving from an indemnity plan, founded fundamentally on what the patient needed, toward a managed care system. The American human service has experienced radical changes inside two eras and keeps on developing. The federal legislation that I have chosen that most significantly influenced the growth of managed care from my point of view are the HMO Act of 1973 and HIPAA.

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

Critics believe that the present functioning of managed-care is degenerative to health care. Managed-care firms control costs by requiring patients to use a “network” of approved doctors and hospitals, and by reviewing the actions of doctors. Patients have to pay more to visit a doctor who does not participate in the “network.” Managed-care firms second-guess doctors, considering only the costs. Patients are often prevented from visiting specialists to reduce costs. A managed-care company might insist that its doctors prescribe inexpensive generic drugs instead of commercial products. Many patients must, also, receive the insurer’s approval before undergoing treatments or operations. HMOs have been criticized for refusing to pay when a patient goes

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

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.

As it is generally assumed, health care is a social component that is mandatory in any developed society. Opponents argue that patients benefit from privatisation as they will have better choices because of the competition spawned as a result. They also suggest that patients will be subject to affordable and quality services (safeguarding free services) since competition will provide different clinical groups the opportunity to solicit valuable contracts that will protect pricing and quality services (El-Gingihy,

I think the biggest problem with health care are the cost of the insurance is insanely overly expensive . The insurance and hospital will charge you whatever they think it's worth for the care and all they think that it was necessary for the time you spent at the hospital . For example I went to see the doctor to get my ears check and so the doctor spent about 20 minutes looking at my ears and I spent about 30-40 minutes waiting and after 2 weeks I receive a bill for 400+ dollars just to get my ear check it's also add that majority of people doesn't have the option to choose or understand what is the best insurance for them not a lot of people understand the insurance because theres nothing to compare with if you buy cars you can compare and

The first thing that I noticed is that there is a shortage of healthcare providers in Southwest Oregon. This is problematic because there are not enough healthcare providers to meet the healthcare needs of everyone who lives in rural communities (Rutledge, Haney, Bordelon, Renaud, & Fowler, 2014). My nursing diagnosis for this would be ineffective health maintenance related to insufficient resources. The members of the rural community are unable to identify, manage, and/or seek out help to maintain their health.