A large number of health care administered in the United States is mainly through managed care plans. Often when the term managed care is raised, there is always a negative reaction from the health care providers. Managed care refers to health care system or health care insurance plan that synchronizes the provision, cost and quality of care for members enrolled. The overall objective of managed care is to domicile administrative control over quality, cost and access to services offered in health care centres.
Positive attitudes of managed care
Managed care encourages cost-effective practice in medicine and it also minimizes disparity in patterns of clinical practice. What this means is that managed care enables provision of health care services with minimized resources used; it mainly minimizes cost (Kongstvedt 2010). Efficiency in managed care is maximized through an increase in productivity with fixed cost. Managed care creates pressure of doing more with less costly medicines, time per patient, cost for treatment and diagnostic tests. In managed care, there is no direct and consistent correlation between quality and cost of care. In overall, the managed care has improved the overall standards since it have created a better understanding of connection between the quality and cost of health care.
Negative attitudes of managed care
However, despite the fact that managed care has managed to improve health care standards, it has been unsuccessful when it comes to profits. This is because it has contributed to an increase in health care cost and rise in the number of citizens who are uninsured. Managed care has also driven away many health care providers and this is why there is always a negative reaction from the health care providers when the term managed care is raised. According to National Committee for Quality Assurance, managed care has lower pressure when it comes to provision of quality services (Kongstvedt 2010). Managed care has caused inefficiencies mainly in health care finance. This has led to inefficiency when transferring insurance risks of health care providers and at times, the providers are not adequately compensated. Small insurers usually have lower probabilities of attaining modest profits as compared to large ones (Cox 2010).
Capitation is one of the ways in which managed care practices use to control health care costs and also seek to impact quality of health care. Capitation mainly involves paying medical doctors a prospective fixed amount for each patient they have treated regardless of how much cost is required to care for a patient. Organizations are always organized between purchasers and physicians on how much discount is to be given to a doctor for providing health care to a specific number of patients (Kongstvedt 2010). Health maintenance organizations, exclusive provider organizations, hospital/physician associations and individual practice associations are some of the examples of managed care.
Monetary incentives are some of the ways used to affect the behaviour of physician such as offering bonuses for those who have delivered the most effective care when it comes to cost. This always motivates physicians, hence, gives them the urge to work more and also provides quality services to their patients. However, those physicians who deliver poor quality services and are cost-inefficient are always penalized. Some portions of their income are always withheld and they are not given any bonuses for any service offered. These nonmonetary and monetary incentives are some of the ethical concerns in managed care when a physician attempt to compromise advocacy of patients with the aim of achieving cost savings (Nancy 2011).
Cox, T. (2010). Legal and ethical implications of health care provider insurance risk assumption. New York: Health Care Journal. Pg: 106-16.
Kongstvedt, P. (2010). Essentials of Managed Healthcare (5th ed.). New York: Jones & Bartlett Publishers.
Nancy, S. (2011). Current Trends and Issues in Managed Care. Washington: Aspen Publishers, Inc.