Healthcare is a service offered by health specialists to patients. Managed Care, on the other hand, is an administrative system developed to control primary health care services by a group of health practitioners. The system is normally aimed at improving health services and reducing the cost of its access. The success of Managed Care is brought by the continued emphasis on health education and relentless campaigns for the use of preventive medicine (Wolper, 2011). This system was first used immediately after World War II (D’Aulti, 2008). Managed Care has enabled patients to easily access health services with the flat fee packages for basic and primary care (Wolper, 2011).
In managed care, the intention, as indicated by Wolper (2011), is to “coordinate, rationalizes, and channel the use of services to achieve desired access, services, and outcomes while controlling costs” (p.78). Health services are increasingly becoming inaccessible due to the rising cost of medical facilities. Medicine and medical equipment are relatively very costly making treatment a costly endeavor. Owing to this, health practitioners have found it important to come up with ways of reducing the cost of health services. One of the most significant steps towards achieving this goal has been the introduction of the healthcare insurance plan. With the demand for health services being on the rise, managed care has become a necessity all around the globe.
Accessing health care services can be quite an expensive endeavor, especially if a patient requires secondary healthcare attention. Health management is, therefore, considered a remedy to mitigate the financial constraints. The high cost of health services has a major influence on Managed Care. This is driven by the increasing rate of unemployment. Responding to the increasing healthcare expenses, employers react to its impact by cutting back on employee benefits (Chaperon, 2009). As a result, only big firms are able to offer health insurance plans to their employees. Small businesses cannot afford to facilitate this plan and remain profitable at the same time.
Containment is another major issue in the Managed Care industry today. Howrigon (2009) indicates that managed care companies have turned from Healthcare oriented service providers into profit-making entities (p.1). He laments that these companies considered human suffering as a profitable opportunity to make money (Howrigon, 2009). Managed Care companies took advantage of the increasing need for health services and turned it into a money-making opportunity. Through this, they have made indescribable amounts of money. The tragedy is that while these companies are profit-driven, their services are becoming more inaccessible to the greater majority of people.
This practice contravenes the spirit and intention of Managed Care. However, unlike the earlier health care plans, today’s modified strategies have enabled the industry to be more flexible. In the early stages of managed health care, Health Maintenance Organizations were not as flexible as they are today. They existed in two iconic models that nowadays are referred to as the staff-model and group-model HMOs (Showen, 2008). With these plans, the contracted doctors were not allowed to work or be a part of a different health service-providing organization. They exclusively worked for the HMO with which they had been contracted.
The group model is similar to the staff model. The only difference is seen in personnel contracting procedures. While the staff-model contracts individuals, the group model contracts groups of existing doctors. Nonetheless, a different format of Health Managing Organization was developed. This was referred to as the Independent Practice Association. This particular trend brought flexibility in the health services industry. Unlike in the prior plan, physicians in this plan were allowed to continue with their private practice even after joining an HMO.
However, the trend took a new turn with the introduction of a new plan called Preferred Provider Organization, ‘PPO’. This is the latest invention of health management strategies. The difference between PPO and HMO is the principles guiding their functioning. With HMO, a patient can only get services from a specific team of health care practitioners (Chaperon, 2009). This is quite limiting and restrictive compared to the PPO plan where clients have an option to choose the practitioner according to their preference. This offers more benefits to patients compared to the former plan. Patients are allowed to see a doctor or access a health facility at the option without having to worry about the referral. This also gives the patient the right to go out of network any time they choose to.
PPO plans are the most popular and preferred among employees regardless of the fact that they are slightly more expensive as compared to HMO plans. The extra cost of a PPO plan is nothing compared to the freedom to choose the preferred health practitioner. This is the main strong point in this plan and, on the other hand, the disadvantage of HMO plans. Employees feel restricted and disadvantaged when they are not allowed to use their preferred health facilities. This is the reason why they embraced the PPO plan with a lot of ease. Giving employees the freedom to make their own decisions on the services they get through their income is fair and reasonable.
Managed care is a brilliant invention, and the development in health services is a clear indication of the efforts to increase and develop secure health service insurance plans. Today’s managed care services are characterized by numerous plans provided by different companies. In reaction to the competitive healthcare industry, HMOs have responded with a new competitive product in the market. Many Health Maintenance Organizations have introduced new plans in the market that work almost the same as PPO ones. This plan is referred to as the Point-Of-Sale plan (Howrigon, 2009). It runs just like a PPO plan, but in this case, the preferred choice of a doctor is chosen from within the network of health service providers in that organization.
Competition has played a great and crucial role in improving the trends and plan-formations of Managed Care. It is through the motivation to persuade employees into a health care plan that has led to the current improvement in the industry. Although the battle is not yet over, the current improvement gives employers a good gesture that allows them to hope for a better future. Managed Care has profited many people in the past and will continue to do so in the future if practitioners follow their professional ethics. Service delivery must be the bottom line in every Managed Care company. These services are meant to benefit employees and patients, not for financial gain. The government must also regulate the functions of Managed Care companies. This will ensure total adherence to professional practice and requirements.
References
Chaperon, R. (2009).Managed Care Trends. Web.
D’Aulti, M. (2008). New England Medical Center studying the effects of managed care on the underinsured. Boston: New England Medical Center.
Howrigon, R. 2009. Trends in Managed Care Cost Containment: What Will They Think of Next? Radiology Business Journal, 5(1), 1-2. Web.
Showen, C. (2008). Kaiser Commission on Medicaid and the Uninsured and Urban Institute analysis. Los Angeles: Kaiser Permanente.
Wolper, L.F. (2011). Health care administration: Managing organized delivery systems (5th ed.). Boston: Jones and Bartlett.