Managed care or managed healthcare represents a set of frameworks and principles designed to control the healthcare market. The primary objectives are to reduce the cost of the services, provide the citizens with health insurance, and improve the quality of care. Managed care utilizes various programs in order to fund the facilities and financially support people in need of healthcare services. The emergence of managed care caused considerable transformations in the interrelation between patients and medical care facilities. It provided opportunities to receive affordable care by introducing a list of healthcare packages and funding programs.
According to some sources, the price of health insurance has been increasing rapidly during the past century (Kongstvedt, 2020). Hence, it was essential to develop a specific approach to prevent such growth in medical costs. Managed care was first introduced in the 1980s and played a considerable role in the development of domestic healthcare. However, the overall impact of managed care may appear to be highly controversial. Even though there is extensive evidence of managed care efficiency, particular programs and approaches may remain debatable. In some cases, It may be necessary to reconsider existing healthcare programs in order to improve the general influence of managed care.
Techniques and Types
Managed care utilizes a wide variety of techniques in order to provide citizens with high-quality healthcare services. In some cases, managed care may be viewed as a delivery method as it implements integrated delivery systems. These systems may provide designated doctors and facilities in order to ensure provider network availability. Moreover, patient-oriented techniques, including patient education, disease, and case management, are utilized to achieve a similar goal. Patient education, in conjunction with digital technology development, provides new opportunities in the field of outpatient healthcare. It may be particularly relevant during the current pandemic, yet its frameworks may also be beneficial in the future.
There is a wide list of managed care programs that are aimed at various aspects of healthcare improvement and availability. The most significant programs include Health Maintenance Organization, Independent Practice Association, Preferred Provider Organization, Point of Service, and Private Fee-For-Service. These programs address such problems as rising healthcare costs, the impossibility of choosing a provider organization, and lack of flexibility. The opportunity to choose a suitable insurance plan may be critical in terms of providing high-quality medical care.
Managed Care Impact
Managed care provides considerable benefits to citizens in terms of affordable medical care and insurance planning. As already mentioned, the main advantage is the availability of multiple coverage options. Managed care has become one of the most popular health insurance coverages since the 1980s. Managed care offers patients an opportunity to choose between three insurance plans with diverse payment rates. Health maintenance organizations are designed to pay for medical care provided by a particular health network. Preferred Provider Organizations also cover the payments for providers outside the network. Point of Service plans represents a combination of two previous plans. Another benefit of managed care is represented by lower drug costs. American citizens spend a significant amount of money on prescription drugs annually. Therefore, it is vital to provide high-quality generic drugs for affordable prices under managed care insurance. The vast majority of drug prescriptions may be implemented by managed care.
Delivery models and healthcare accessibility are closely linked with the promotion of health. According to recent research, health service utilization is related to the delivery system, which may be maintained by managed care (Yamaki, Wing, Mitchell, Owen, & Heller, 2019). Furthermore, managed care introduces several financial arrangements that maintain accessibility. One of the most common arrangements is capitation, which plays a considerable role in providing all segments of the population with decent medical care. Such an objective is achieved by placing the providers in the role of micro-insurers. Another recent study shows a strong correlation between the frameworks of managed care and the accessibility of adequate medical care services (Gilchrist-Scott, Feinstein, & Agrawal, 2017). However, there are people who argue about the financial benefits of managed care. Many believe that it is an unsuccessful health policy, which, in some cases, may even lead to an increase in care costs. It may also contribute to a decrease in insured citizens and lower quality rates. Even though such consequences may appear in some cases, they are predominantly linked to poor implementation of the policies, irrelevant management, and even law violations. It may be possible to decrease such controversial consequences by providing a more comprehensive analysis of managed care programs and introducing proper control of related organizations.
Managed care may be beneficial in terms of access, financing, and delivery of health care in the United States. Furthermore, its positive impact on the transfer of health services to outpatient care contributed to the provision of high-quality services and the development of new approaches during the pandemic. Even though managed care influence may not always be evident, and in some cases, its positive effects may be debatable, it provides necessary frameworks which improve healthcare accessibility and hence promotes health. Further studying may contribute to the further expansion and development of managed care programs.
Gilchrist-Scott, D. H., Feinstein, J. A., & Agrawal, R. (2017). Medicaid managed Care structures and care coordination. Pediatrics, 140(3).
Kongstvedt, P. R. (2020). Health insurance and managed care: What they are and how they work. Jones & Bartlett Learning.
Yamaki, K., Wing, C., Mitchell, D., Owen, R., & Heller, T. (2019). The impact of MEDICAID managed care on Health Service Utilization among adults with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 57(4), 289-306.