The term “managed care”

The term “managed care” describes a variety of strategies whose primary goal is to lower the costs involved with providing health benefits while also improving service quality. Some of the healthcare services available include economic incentives provided to physicians and patients, allowing them to access high-quality kinds of care despite their high cost (Chan Hong Kit, Abdul Rasid & Md Husin, 2016).

What are the distinctions between managed care and traditional indemnity insurance? There are several distinctions between typical indemnity insurance and Managed Care. Traditional health insurance, for example, allows an individual to select the health professionals of their choice. Additionally, a person utilizing the traditional health insurance is provided with an option of paying for the services after they are administered and later submitting the provided bill to an insurance company for the sake of reimbursement (Marton et al., 2016). In most cases, the providers submit the presented bill directly to insure an individual. On the other hand, managed care combines financing and delivery of the administered care services at a go. The process has been accepted over the years and that has remained to be the main procedure when it comes to managed care. Also, managed care has the potential to restrict the choice of hospitals and doctors. However, in return, an individual typically pays less for the administered medical care in comparison to traditional indemnity insurance. Furthermore, the managed care network will control and provide a direct access to the provided healthcare services.

Fee for service has led to uncontrolled utilization of healthcare hence the increased costs of healthcare. Under fee-for-service, the provider is billed separately for all the administered bills for the delivered services. Additionally, the providers implementing the fee-for-service always set their service fee at high prices which are also considered as unreasonable. Apparently, the situation is achieved through the billing the insurance company on an item-by item claim. According to Moffat (2016), the insurance companies had minimal incentive of controlling cost. As a result the premiums are increased during the subsequent years.

Barriers and Facilitators

The main barrier noted to the implementation of the managed care system is the lack of evidence-based care needed to support the system. According to Marton and Yelowitz (2015), it is a requirement that evidence based care must exist to support managed care with an aim of ensuring a society with healthy patients. Apparently, information is considered as a key. Information is an important requirement needed to manage patient system to achieve a workflow process. Under managed care, having real-time data is considered a necessary requirement to ensure effective implementation of the system for maximum quality management. Information leads to better decisions regarding the managed care system which further leads to a better health.

The main facilitator to the implementation of the system is the fact that various health insurances have been established with an aim of providing quality care to the people. As a result, an intensified competition is noted within the healthcare system. The presented fact has contributed to the implementation of the system to ensure the desire of the Americans to have manageable quality care is achieved. With managed care, Americans will not only access quality care but also enjoy the effectiveness that comes along.

Improved Effectiveness

Managed healthcare has improved the effectiveness of healthcare delivery in the United States. Wang et al. (2016) documents that in the United States, managed care has played a significant role in reducing the general costs of healthcare. Additionally, managed care has also significantly improved on the quality of care administered hence its rapid growth since the 21st century. With this, competition within the healthcare industry has also grown significantly within the industry. With the intensified competition, the quality of service and patient satisfaction is also achieved. Additionally, the improved competition also results to an efficient resource management. With this, it is clear that managed care has focused on quality outcomes. As a result, it has become increasingly critical in the development of a sound strategy for the provision of an effective care which is appealing to patients since it focuses on controlling the high costs of healthcare which is common in the United States. Generally, the healthcare system is faced with the challenge of retaining and attracting employees who are qualified and talented. As a result, an effective and efficient healthcare service is delivered consistently.

Conclusion

To conclude, managed care has played an important role in promoting patient satisfaction in the United States. The system has enabled patients to access quality healthcare despite the undesirable high costs of healthcare in the region. The fact that managed care allows for a third party to pay for the administered costs of healthcare have driven the rates of patient satisfaction higher in the region. The major barrier noted to the implementation of managed care is the lack of evidence based care. Through this information about the system is obtained. Information is key within the presented system to ensure the maximization of the system’s requirements and provision.

References

Chan Hong Kit, P., Abdul Rasid, S. Z., & Md Husin, M. (2016). The impacts of Malaysian managed care on doctor–patient relationships, ethical practice of medicine, and quality of care: A study on primary care physicians’ perception. International Journal Of Healthcare Management, 9(2), 119-126.

Marton, J., & Yelowitz, A. (2015). Health insurance generosity and conditional coverage: Evidence from medicaid managed care in Kentucky. Southern Economic Journal, 82(2), 535-555.

Marton, J., Yelowitz, A., Shores, M., & Talbert, J. C. (2016). Does Medicaid Managed Care Help Equalize Racial and Ethnic Disparities in Utilization?. Health Services Research, 51(3), 872-891

Moffat, J. C. (2016). Chapter 10: EMTALA and Managed Care. EMTALA Answer Book, 1-26.

Wang, S. Y., Blachley, T. S., Andrews, C. A., Ayanian, J. Z., Lee, P. P., & Stein, J. D. (2016). Hospitalization after Cataract Surgery in a Nationwide Managed-Care Population. Plos ONE, 11(2), 1-14.