Managed care entails a group of activities that are intended to cut the costs of provision of healthcare services for profit and at the same time, achieve the intended quality of care. The managed care revolved at a remarkable rate since its inception until the 1990s. From then, there has been a drastic deterioration in the quality of services delivered through managed care.
Factors leading to the rise of Managed Care between the mid-1970s to the late 1990s
Many factors tremendously contributed to the increase of managed care between mid-1970s and the 1990s. First, several tools and techniques were utilized by the managed care organizations to decrease the hefty charges of healthcare. One of the tools included the establishment of provider networks and selective contracting, pre-authorizations and utilization reviews, preventative medicine and usage of primary healthcare physicians. The tools made a tremendous and distinctive effect on medicine practice (Ginter, Duncan & Swayne, 2018).
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In the earlier days of managed care, selection and a subsequent usage of network physicians was an important aspect that mostly distinguished the fee for service system from managed care. In earlier systems, patients could only see a doctor of their own like. The patients did not worry whether insurance corporation could reimburse the visit or not. Managed organizations made these healthcare institutions were more efficient in their operations (Ginter, Duncan & Swayne, 2018). The managed care institutions could get into personal contracts with personal doctors. Their patients were permitted to see a network of doctors, who were also developed by particular groups. The managed care organizations do not refund any physician visit outside the network. An approval had to be seconded by the healthcare plan. The selective contracting assisted in elevating communication amongst the physicians and thus few errors were realized in the care of patients. It was also utilized to attain a top-notch team of physicians. The earlier managed care system was equally better-coordinated (Ginter, Duncan & Swayne, 2018).
The establishment of the networks helped the managed care institutions to minimize costs. Through setting up the contracts, the managed care organizations hired physicians on contracts from whom they could get high values of discounts ( Smith & Goodwin, 2017).
Healthcare Costs Implications in the U.S
There are many implications based on the soaring costs of healthcare to the U.S families. There is a rise in the number of people that are underinsured or uninsured. Due to the rise in costs, the employer coverage has immensely declined to lead to a rise in the number of people that lack health insurance. A number of adults are insured and have a huge out-of-pocket cost that is not commensurate to their salaries ( Mackie, 2018)
Because of the higher costs, a number of employees are dropping the coverage or have opted for the cost-sharing line of bargains. Most adults are actually undergoing many struggles in paying the medical bills. It is now reaching a state within the US where only a small fraction of the entire populace contributes to the insurance schemes ( Mackie, 2018)
Lessons from this Period
Quality care is a key ingredient for the growth of any nation. A sick nation can rarely experience economic progress. Managed care is a good program if efficiently managed. The costs of managed care should be manageable for the benefits to be realized.
Conclusion
Managed care is a good plan if properly managed. It has evolved from a season where it was affordable and efficient to a season where the costs have soared and not tenable to most citizens. The federal government should reevaluate the insurance costs to assure usage
References
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health care organizations . John Wiley & Sons.
Mackie, T. (2018). 69.4 Managed Care Organizations, Quality Improvement, and Antipsychotic Medications: Prescribing in Children and Adolescents in Foster Care. Journal of the American Academy of Child & Adolescent Psychiatry , 57 (10), S100.
Smith, J., & Goodwin, N. (2017). Towards managed primary care: the role and experience of primary care organizations . Routledge.
