Managed Health Care



Abstract

Managed care refers to a vast array of organizational and financial arrangements intended to control health care costs and improve quality of care. For most of its history, health care in the United States has been a fee-for-service system. Physicians were paid for the services they provided families and had almost complete control over decisions about treatment. Some believe that paying for medical care on the basis of quantity alone gives providers an incentive to provide more services than medically necessary. Managed health care directly challenged the system of fee-for-service in an effort to rearrange these incentives. In this paper, I try to focus on the managed care. The paper will discuss about the accountable care organizations and denied treatments for patients.

Table of Content

Abstract2

Introduction4

History4

Methodology4

Discussion5

Accountable Care Organizations5

Health Care Reform6

Managed Health Care for Patients6

The Effect of Managed Care on Costs and Quality7

The Managed Care Backlash7

Developing Managed Care8

Conclusion9

References11

Managed Health Care

Introduction

People with disabilities often face a multitude of problems seeking and receiving needed healthcare services. To systematically address some of these problems, this chapter uses the conceptual framework of health services research. Health services research is a multidisciplinary field that focuses on the study of the access, costs, quality, and outcomes of healthcare services. Access to healthcare consists of everything that facilitates or impedes (i.e., geographic barriers, and not having health insurance coverage) the use of healthcare services. Costs of healthcare include provider costs and charges and the payments made by insurers and individuals for healthcare services.

Quality of healthcare encompasses the elements of structure, process, and the outcomes of healthcare. Outcomes of healthcare generally include such measures as changes in mortality (deaths), life expectancy, morbidity (diseases, injuries, and conditions), disability, degree of pain or discomfort, and patient satisfaction with the care they receive. Ideally, all health professionals and healthcare organizations should strive to provide their patients and the communities they serve with the greatest possible access to care, at the lowest possible costs, and with the highest possible level of quality, and to achieve the best possible outcomes of care. Health services researchers work to improve the effectiveness, efficiency, and equity of healthcare, mainly by influencing, developing, and evaluating public policies. Effectiveness may be broadly defined as meeting the stated goals and objectives of a program or organization, efficiency as the ratio of inputs to outputs, and equity as fairness or justice (Mullner, 2009).

History

The origins of managed care can be traced back to the early 1900s. In 1929, physicians began contracting with unions to provide comprehensive medical care for a predetermined fee. Impressed with such arrangements, Henry Kaiser offered prepaid services to his shipyard and steel mill workers during World War II. The growth of managed care was made possible when Congress passed the Health Maintenance Organization Act in 1973, which permitted the growth of prepaid health groups.

The rapid expansion of managed care beginning in the 1980s was partly a response to an apparent crisis in the U.S. health system that was marked by spiraling costs and concerns about the quality ...