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Managed care plan
Managed care plan
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Introduction Managed care plans present as forms of health insurance covers. These plans have contracts with medical facilities and health care providers to offer care for clients at decreased costs (Dixon, Greene & Hibbard, 2008). This paper will discuss the criticisms that have been addressed regarding managed care, and the different features that are included in a CDHP. Additionally, it will discuss the existing differences between the choice of providers, cost sharing, and covered benefits of HMOs and CDHPs. This will help in drawing conclusions regarding the latest information that surrounds managed care. Criticisms/Drawbacks of Managed Care Ethical and Legal Issues In worst case settings which, incidentally, take place more frequently …show more content…
Physicians hold responsibilities to their personal patients, but also responsibilities to the patient populations for whom they are held accountable (Rhodes, Francis & Silvers, 2007). Additionally, they are expected to advance and support the growth of medical science. Nevertheless, the most recent criticism has been accorded to the allocation of resources. As much as physicians are appropriate or designated communal resource custodians, they need to be conscious of the quality or cost of medical care. The American healthcare system is badly broken, we are in the grip of a very bid industry that will never stop making money. The healthcare aspect of today economy depends on the financial aspect. You cannot get or receive medical care without insurance. Some people are offered free healthcare which tax payers pay for. This help people who or poor, low income or middle class however. I will write about why the healthcare industry is such a financial burden to poor, middle class and pre-condition people. How the medical industry charge $1,500 for 5 minutes for someone to put a needle in you but $15 for 45 minutes for someone to exam …show more content…
We don’t have a healthcare system in America that care for people it’s a number game based on how many people are seen. The more medication a person is on the more money the heath care makes. We will never have single-payer or universal healthcare because the insurance companies. I work for a home health care company and I am not happy I am pissed off every day knowing there are so many people out there that need our help but due to the fact they don’t have Medicare we must refuse those people.99% of home health care companies are like this. Who really care for people that are sick. In Africa if you have no money the doctor won’t see you they hospital will leave you outside to die. I feel as if America is not that different from Africa the rise of healthcare make it often hard for people to afford healthcare, I have a friend who has Medicare and she is on a fix income with COPD and several other illness and was told as of 2017 the will deduct more money from her ssi check and she stated if they do that she won’t be able to pay her bills and she will have to go without healthcare
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
Doctors play a major role in society today because doctors will use medicalization to gain power to their name or to their practices and more importantly their income. Another reason why medicalization is apparent in society has also to do with MCOs. MCOs are health insurance providers that restrain costs by monitoring closely the health services given to patients. MCOs either support or oppose medicalization, depending on which tactic best protects their interests (Weitz, 2012,
A managed care organization is a collection of clinics, doctors, hospitals, pharmacies and other healthcare providers who come together to offer health care to persons who are sign up for the services. In many cases, managed care organizations operate and are referred to as networks of health care providers. Managed care organizations are comprised of health care experts from different fields who come under an agreement to offer health care services to members. Once a member signs up, all their heath care needs are covered by the managed care organizations. Access to care outside the organization is restricted. Members under managed care organizations are usually assigned a primary care physician (PCP) who is the primary care giver for the member. The PCP is tasked with analyzing a member’s health problem before referring them to other sections of the managed care organization. Managed Care Organizations are usually well coordinated to meet the needs of members who have registered under their banner.
Despite the established health care facilities in the United States, most citizens do not have access to proper medical care. We must appreciate from the very onset that a healthy and strong nation must have a proper health care system. Such a health system should be available and affordable to all. The cost of health services is high. In fact, the ...
The U.S. expends far more on healthcare than any other country in the world, yet we get fewer benefits, less than ideal health outcomes, and a lot of dissatisfaction manifested by unequal access, the significant numbers of uninsured and underinsured Americans, uneven quality, and unconstrained wastes. The financing of healthcare is also complicated, as there is no single payer system and payment schemes vary across payors and providers.
The paradox of excess and deprivation in the United States health care system is that some people receive too little care while others receive too much care. There are certain groups of people who receive too little care or do not receive care in a timely manner. For example, if a person is uninsured or have Medicaid, they will have to wait a longer period of time to be treated for illnesses and receive appropriate tests. Other groups of people who are elderly or insured receive additional care which leads to too much excessive care. Elderly people are most likely to have health problem, so they run more test like CT scans or MRI scans and do more medical procedures that are basically unnecessary. Due to the health crisis in the United States, it is very confusing why they will give additional care or perform unnecessary test. This is a good topic to just trying to get paid more money by giving additional care.
According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth
According to Roy, 2013 the issues of providing the affordable care act will unite both the supporters and offenders of the public policy, but in this current situation where the input costs are rising, it will become impossible for government in managing the public policy related to affordable health care. In order to provide affordable health care, majority of the US government has tried out different policies time to time, but unable to get success in realizing the actual policy goals. By providing the affordable health care to majority of the people who requires more amount as controlling the input cost is not possible (AAMC, 2013). Lack of doctors is one of the primary issue in providing high quality health care to the citizens especially those who are financially poor. The Supreme Court of the country passed an Act related to Health insurance as all should have Health Insurance to all the country people by the year 2014, but the at the same time government is concerned about constitutionality of these act (NYTimes, 2013).
Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel.
To conclude, health care is a primary responsibility of governments. They have to make sure that everybody has a total insurance which ensures equality between all members of the society with no segregation between rich and poor. Marxist theory mentioned that medicine became a profitable project more than a human task to serve people and save their lives as it was linked to capitalism. John, the poor factory man was guilty for doing such a sever action to keep hostages but at the same time he wasn’t guilty to be poor and didn’t have an insurance to save his son’s life. Physician role is to be fair when dealing with patients and to think of morals and ethics of the profession before thinking of money.
With the United Nations listing health care as natural born right and the escalating cost of health care America has reached a debatable crisis. Even if you do have insurance it's a finical strain on most families.
The positive impact of managed care plan to Medicaid beneficiaries is that it has the potential to improve the quality of care as managed care promises care coordination and improved attention to primary care services, both of which are largely ignored in fee-for-service systems. On the other hand, the negative impact if managed care plan to Medicaid beneficiaries occur when it is not effectively implemented and well designed. The aim of Medicaid managed care to control cost can have an adverse impact on people with disabilities, whose chronic conditions may require expensive surgeries, adaptive equipment, and ongoing or ancillary
At this point in time there is great disappointment with the medical system that is in place. This is according to a recent Harris Poll survey, which found that 56 percent of the public, 46 percent of physicians, 48 percent ...
In the past when there were no managed care plans the beneficiaries would be allowed to go to any doctors, now because of managed care they have one primary doctor who manages their care and refer them to other types of doctors if necessary. Managed care has its pros and cons, in one way it is good to have one doctor taking care of you all the time but at the same time it is very restricting when you either want or must go outside of your network. In my opinion, I do not care for managed care because of an experience I had over 20 years ago. My daughter was a child and had an asthma attack, the ambulance took me to a nearby hospital but when I called to alert my managed care on her condition, they told me I had to go to another hospital that