Health Care Reform: Managed Care Essay.

Health Care Reform: Managed Care Essay.


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. ). Though Managed care initially addressed several health care finance issues, there are still problems with the current managed care system. Examining these issues, researching managed care, and possible solutions can enable health care providers and consumers to address and implement new solutions to the current managed care system. Managed Care Managed care is a health care delivery system that in some way places the provider or a manager in the position of managing the utilization of health care by the consumer.Health Care Reform: Managed Care Essay.


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The advantages of managed care from a consumer’s perspective are the predictable cost for health care, such as a copayment. In addition, managed care encourages consumers to use preventive care, such as screenings and immunizations. The disadvantages with many managed care plan is the consumer most choose an affiliated physician, the need for prior authorization before hospitalization, surgery, and specialty care, and the out-of-pocket cost to the consumer if treatment is outside the network of physicians.


Consequently “Because the managed care organization (MCO) takes financial responsibility for medical care, it has an incentive to provide care efficiently. To remain viable, it must compete on the basis of both quality and cost” (Getzen & Moore, 2007, p. 204). Managed Care Regulations in the States The article, “Managed Care Regulation in the States: The Impact on Physicians’ Practices and Clinical Autonomy,” reports the results of an analysis of the impact of managed care systems on the way physicians can practice.Health Care Reform: Managed Care Essay.

Competition of the analysis was done by combining information from state laws and survey responses. The impact of managed care regulations was assessed by comparing the differences in a physician’s clinical autonomy and practice experience in states that have adopted managed care regulations and states without these regulations; along with the impact of regulations on certain providers based upon the level of involvement by managed care systems.Health Care Reform: Managed Care Essay.

The results of the study showed that unregulated states displayed a decrease in physician autonomy because of managed care; physicians who had a high level of managed care involvement reported lower levels of clinical autonomy, quality of interactions, and ability to obtain services when compared to physicians who had limited involvement of managed care systems (Kronebusch, Schlesinger, & Thomas, 2009).

What Doctors Think The article, “What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients;” takes an in-depth look and assesses how doctors feel about the impact of managed care about factors such as quality of care patients receive, the control of health care costs, professional autonomy, and the doctors relationship with patients.

Conduction of this assessment is done with a mail in survey of all active physicians who practice in clinical care, work at public hospitals/private hospitals, and have been board certification or are still training. Participants were asked to rate the impact of eight managed care tools on four aspects of care on a five level scale, five as very positive and one as very negative. A mean score from the four aspects of care was gathered upon completion.Health Care Reform: Managed Care Essay.

The eight managed care tools used in this study were “guidelines”: patients access to specialists guided by a primary care doctor, necessity to ask the insurance carrier for an authorization before and hospitalization, necessity to ask for a second medical opinion for any costly investigation or treatment, doctors participation in health care networks, which coordinate care for affiliated patients, possibility for the insurer to choose which doctor he will reimburse, doctor’s pay for performance base on cost control/patient satisfaction/or quality performance, and payment salary.Health Care Reform: Managed Care Essay.

The four impacts used in this analysis were professional autonomy, control of health care costs, quality of care, and relations with patients. The results of the study showed that most doctors had negative opinions about the impact of managed care; the impact on control costs was positive but the impact on professional autonomy was mainly negative. The study showed both the negative and positive sides of managed care from the viewpoint of a physician (Agoritsas, Bovier, Deom, & Perneger, 2010). The Metamorphosis of Managed Care

The article, “The Metamorphosis of Managed Care: Implications for Reform Internationally,” states that the government and others have used the tools of managed care to encourage different intentions. These intentions range from accessing medical care, to limiting medical spending, to stopping physicians to become entrepreneurs, and helping the health care markets and insurance companies to grow. This article helps to discover how managed care changed the doctor’s conflicts of interests and the responses to those conflicts. The article also states how managed care adjusted the voices of patients or consumers to promote change (Rodwin, 2010).

Since the early 20th century, managed care in the United States has changed from prepaid group service (PPGP), to health maintenance organizations (HMOs), to managed care organizations (MCOs), and changed from not-for profit to for profits (Rodwin, 2010). The United States along with other countries try to find ways to control medical costs. In 2009, the United States changed HMOs into accountable health organizations in which hospitals and doctors form an alliance and take financial and management responsibilities for their patients (Rodwin, 2010).Health Care Reform: Managed Care Essay.

France changed how they did their billing and started using state managed care. By 2012, Japan should be processing all claims through electronic billing. Instead of fee-for-service, Japan is using per-diem and bundled payments to pay physicians and hospitals. No matter how a country looks at it managed care tools are still around, and they will always be. The government just needs to listen to the voice of its people (Rodwin, 2010). Solutions to Managed Care People are aware that managed care has caused patient free will to be lost in the sprint to cut price.

Insurance companies in this sense control patients rather than self-monitoring or by a physician. One wants to make their choices. Managed care -whether in the form of HMOs, PPOs, etc. , or limits on service- is an attempt by the payers (insurance companies, federal agencies or self-funded groups) to restrict payment for services and procedures the payers consider to be unnecessary (Singer, 1997). One way to assist the patient in understanding why the cost is set is the use of outcome studies.

An outcome study is a study done on a select group of patients with select problems that proves the outcome in terms of statistical results and costs (Singer, 1997). The use and understanding of studies are a solution to managed care. Litigation can be a solution to managed care also. Denial of health care should not be a concern, but in society it is. Denial of health care insurance should not be a concern, but presently it is. Living in a poor part of a town or city should not limit the quality of care one receives.

For every person no matter the stature, cause the use of litigation. According to the U. S. Department of Health and Human Services, “Americans spend proportionately far more per person on the costs of litigation than any other country in the world. The excesses of the litigation system are an important contributor to “defensive medicine”–the costly use of medical treatments by a doctor for the purpose of avoiding litigation” (U. S. Department of Health and Human Services, 2011). If litigation was not so sharp, people could obtain the needed care without limitations.Health Care Reform: Managed Care Essay.

Employers do not have the same interest in the insurance as the employee. An employee wants insurance that cover all his or her needs but wants the cost to be low. The employer wants his or her employees to be healthy. The article, “Solving the Problems of Managed Care,” states, “Under this one-price-for-all rule, the premiums sick people pay is well below the expected cost of their treatment, whereas the premiums of healthy people are substantially higher” (Goodman, 2011). A solution for this problem is that of individually owned insurance.

Employers should help employees attain personal owned insurance by furnishing information, and bargaining group price cuts. When employee purchases insurance personalized to his or her wishes, he or she is to have moveable coverage that follows the voyage through the career market. So freedom for an employee to choose insurance can be a solution to managed health care solutions. Conclusion Health care economics and the cost of health care services is a majorly debated topic in this country presently. Several factors and issues that contribute the rising cost of health care services.

One of the issues is that of managed care. Researching issues with the current managed care system leaves the opportunity to find plausible solutions to advance the current managed care system. By addressing these issues and mending the concerns of managed care, meeting the original of goal of reducing health care cost can be obtainable.Health Care Reform: Managed Care Essay.