Managed Health Care Issues

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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.

With the high degree of variations in health care, patients can be under or over treated or even treated with the wrong treatment for their illness. These unwarranted care techniques can be categorized into three different situations. The first category of unwarranted care is the use of evidence or lack thereof, based on other medical care. The way to explain this category is that a care plan for a patient is proven effective without any proof as to why. The example given by Kongstvedt (2007) is the use of beta blockers post heart attack. Beta blockers prove to be effective in nearly one h...

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...rnational Journal for Quality in Health Care, 14(1), 5-13.

Jacobson, P. (1999, July/August). Legal challenges to managed care cost containment programs: an intital assessment. Courts & Managed Care, 69-85.

Kongstvedt, P. R. (2007). Essentials of managed health care. Sudbury, Mass: Jones and Bartlett.

McGlynn, E, Asch, S, Adams, J, Keesey, J, & Hicks, J. (2003). The quality of health care delivered to adults in the united states. The New England Journal of Medicine, 248(26), 2635-2645.

Rodwin, M. (1996). Consumer protection and managed care: issues, reform proposals, and trade-offs. Houston Law Review, 32(1319), 1319-1381

Starfield, B, Cassady, C, Nanda, J, Forrest, C, & Berk, R. (1998). Consumer experiences and provider perceptions of the quality of primary care: implications for managed care. The Journal of Family Practice, 46(3), 216-226.

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