Three major drawbacks of managed care
Managed care in the United States is the leading form of healthcare insurance whose popularity gained momentum in the last decade. It was initiated to propose solutions to the expensive health care in the 1920s and 1940s. Although managed care was adopted to save money paid by employees (or employers for employees) to healthcare providers, it has three major criticisms.
The managed care is characterized by rigidity in the options of healthcare providers. Employees have to choose healthcare providers from the participating facilities. This denies policyholders the freedom to choose their doctors outside the network. Employees might be forced to be attended by specialists who are not familiar with their illness history. For example, an employee might have changed an employer and, therefore, is forced to adapt another network of healthcare providers. This rigidity denies employees the flexibility to visit the healthcare providers they wish (Simonet, 2005).
The managed care is very strict on procedures to be followed before receiving treatment (Simonet, 2005). Health insurance representatives have to approve treatment before it is given to a patient. Also, a patient has to wait for long to have an appointment with a specialist from the network. This means that the condition or disease will have worsened, and by the time the patient receives treatment he or she might be critically ill.
The managed care providers have been accused of offering unnecessary treatment in an effort to spend less money on a patient (Simonet, 2005). This is common in healthcare facilities whose physicians prescribe drugs for patients to buy from the chemist instead of doing thorough laboratory diagnosis and providing medication based on the results. Due to these observations, patients prefer out-of-network facilities where they are provided with better diagnosis and treatment at a higher cost than within the network.
The major features of a consumer-driven healthcare plan (CDHP)
In a consumer-driven healthcare plan (CDHP), an employer contributes an amount of money that goes into an employee’s Health Reimbursement Account (HRA). This amount ranges from 1,000 USD to 2,000 USD per year. An employee accesses the funds in HRA at the end of the year to pay for the healthcare provided (Robinson & Ginsburg, 2009). If the funds are not sufficient, then the employee has to pay the extra money from his or her pockets. On the other hand, extra funds for the year are carried over to the following year (Robinson & Ginsburg, 2009). This feature of the healthcare plan offers the policyholders the power to control their own accounts.
The CDHP is an improvement from the traditional healthcare insurance which could not accommodate any complex medical procedures. The CDHP gives more attention to personalized treatment and well being of the patient than the traditional healthcare insurance plans. For instance, parents-to-be would like to undergo genetic tests to determine the chances of giving birth to a baby with a genetic disease. Traditionally, no healthcare insurance could deal with such a fundamental test.
Nevertheless, the new CDHPs accommodate genetic tests. Hence, the customer-driven health care plans address the holistic health issues of the current and future generations. A couple would also take their abnormally developing child to a therapeutic school for children using funds from an HRA plan (Robinson & Ginsburg, 2009). Such an arrangement is not accommodated by the traditional healthcare insurance.
The CDHP is focused on both curative and preventive healthcare (Robinson & Ginsburg, 2009). By concentrating on preventive healthcare, the plan is geared towards saving costs incurred by the insured employee. This feature has attracted many employees to the CDHP policy.
Comparing the differences between a managed care plan (HMO or PPO) and a CDHP plan in terms of choice of providers, covered benefit, and level of cost sharing
The CDHP and managed care plans have different characteristics in their terms of choice of providers, covered benefit and level of cost sharing. This essay will compare the PPO plan in managed care and the HSA in CDHP. The PPO plan does not give its policyholders the freedom to choose healthcare providers while the HSA policyholders can visit health care providers of their choice (Hurley, Strunk, & White, 2004). The PPO plan gives preference to doctors within the established network of healthcare providers. The HSA plan in CDHP gives the policyholders the power to choose their own providers. In fact, the HSA plan doesn’t establish networks for their members (Robinson, 2005).
The HSA plan offers more benefits than the PPO plan. The PPO plan limits members on the complexity of medical procedures to be executed while the HSA plan accommodates even the very complex genetic diagnostic procedures (Robinson, 2005). In terms of cost sharing, the HSA plan might call for patients to pay high deductibles and low premiums as compared to those in the PPO plan. In the PPO plan the deductibles are only high when patients visit doctors outside the network, but they also have to pay co-insurance and co-payment (Hurley, 2004).
References
Hurley, R. E., Strunk, B. C., & White, J. S. (2004). The puzzling popularity of the PPO. Health Affairs, 23(2), 56-68.
Robinson, J. C. (2005). Health savings accounts—the ownership society in health care. New England Journal of Medicine, 353(12), 1199-1202.
Robinson, J. C., & Ginsburg, P. B. (2009). Consumer-driven health care: promise and performance. Health Affairs, 28(2), 272-281.
Simonet, D. (2005). Patient satisfaction under managed care. International Journal of Health Care Quality Assurance, 18(6), 424-440.