Description: Preferred language style: English (U.S.). Prepare a 1,050 – 1,400 word paper in APA format discussing how the evolution of health care delivery systems has influenced current health care systems. Select one of the following systems: HMO’s, Medicare/Medicaid, managed care, or insurance companies. At least two references are required.
In this paper, I would be discussing how the evolution of healthcare delivery of managed care organizations. These are healthcare organizations that provide healthcare services in the form of health packages for the convenience of the people so as to ensure that the cost of the services is combined with the cost so that the healthcare needs of the individual is fulfilled. It is more of a customer-driven approach for provision of the healthcare services. The quality of the services and the cost of the services are integrated by the managed care organization (Kyomen, 2005, Fairfield, 1997 & Sauber, R. S., 1997).
More than 60 % of the US population have subscribed to managed care packages. The Managed care organization or the Health Maintenance Organization (HMO) would arrange for all the facilities to provide healthcare services to its customers. The managed care organization would do away with expensive procedures, tests, options and duplications, and instead provide greater amount of preventive care, short durations of hospitalizations, etc. The organization would be providing patient care in the form of a healthcare team that would consist of physicians, specialists, nurses, and other healthcare professionals. Treatment in the managed care involves allocating a greater amount of work from the physician to other healthcare professionals. Several aspects of medical care including psychiatry, disease management, geriatric care, etc, can be managed adequately under the managed care packages. All unexpected costs of healthcare are reduced and unpredicted expenditures are well managed. The individual has the option of selecting a managed care package that would suit his or her own needs. All decisions made under managed care plans are purely evidence-based.
The managed care organization would usually not interfere with the treatment of the patient. However, people also find that managed care has certain deficiencies, which include poor coherence, lack of organizational integrity and consumption of a huge number of resources. Frequently, due to the difficulty in managing the resources, managed care provides excessive treatment or under-treatment to the patient. As the physician is unable to interact with the patient much, the quality of the services may decrease. A managed care would have three aspects, including the manner in which the health policy is operated, the health policy itself and the manner in which the patient is treated.
The HMO’s would form the micro-units of the managed care system. Each of these micro-units would have a quality control system in process. Once these systems are functional, the quality standards of the HMO would improve. In this way, the quality of the entire macro-unit would also improve. The operational processes of managed care would be performed basically by the administration. They would have to interact with the clinical departments to ensure that the resources are effectively utilized, the quality standards are met and the organization is able to meet with the objectives (Kyomen, H. H., 2005, Fairfield, 1997 & Sauber, R. S., 1997).
In the US, several healthcare approaches were implemented in the 19th century itself, which helped in the development of the managed care system. The local groups especially workers and rural populations wanted their health needs to be covered. They paid sums of money to the physician to pay for services for a certain period of time. Slowly several government departments got interested in these prepayment schemes. In Oklahoma, Dr. Shahid began to provide prepaid healthcare services to employees and their families belonging to the local government departments. Soon this scheme extended to other cities including LA. Slowly the contract system of providing healthcare became popular with the masses. The employers began to show interest in ensuring that their workers were fully protected. Dr. Garfield began to provide prepaid health services to employees belonging to the construction industry in LA in the year 1933. His services were quite popular with the workers and several companies subscribed to his services to ensure that health of their employees. During the World War II he provided his services to many steel and shipping companies. Following the World War, he extended his health packages to the general public. The retrospective use of healthcare facilities by the customer was determined in this phase (TMCI, 1998).
During the later stages, managed care began to think prospectively rather than retrospectively. Policies were being developed that would ensure that this healthcare system was regulated. Hospitals began to provide insurance for the general public. The employers became more and more interested in providing healthcare facilities for their workers. This was a legal requirement that several of the employers had to ensure for their employees. Slowly as the need of managed care increased, so the system became more and more complex and the effectiveness began to improve. The high-risk groups also had basic services for them. Initially, the managed care services were provided to the general public who did not suffer from disease.
However, slowly things began to change and it was now provided to those who suffered from a particular disease. To all the service providers, certain guidelines were now available which ensured that healthcare was provided only if certain criteria were fulfilled. Besides, these guidelines ensured that the physician-patient relationship was maintained. A financial pool was setup to ensure that the providers who guaranteed quality services under managed care could be given incentives. Slowly, as a national policy for managed care was framed and implemented, then it was up to the policy-makers to improve the standards and quality. Several functional units that actually delivered healthcare began to work in an effective manner and appear attractive to the patients. The services were integrated under one roof. The information services were also improved so that data could be accessed and modified at any point in a HMO. Several monitoring tools were also setup in order to ensure the delivery and utilization of managed care.
The entire managed care development can be classified into generations, and most of the HMO’s are now able to reach the fourth generation. The fifth generation managed care organizations are those that would develop and utilize specialized anticipatory skills (thus help manage the most difficult cases). In this way, the managed care organizations can compete with other healthcare organizations. If such a high level of care is provided in the managed care system, then the general public would be considering a managed care package rather than any other health financing scheme. The policy also aims to improve the quality of services and the relationship between the patient and the physician. Nowadays, the informed consent process is being given a greater amount of importance, and managed care organizations are trying to give greater control to the patients. Managed care organizations are also improving to the public health delivery system. This would ensure that the health needs of the general public are studied and a policy is framed depending on the healthcare needs (Fairfield, 1997).
Farfield, G., Hunter, D. J., Mechanic, D. Et al (1997), “Managed care: origins, principles, and evolution.” BMJ 314, 1823. http://www.bmj.com/cgi/content/full/314/7097/1823
Liberman, A., and Rotarius, T. (1999). “Managed Care Evolution-Where Did It Come from and Where Is It Going?” Health Care Manager 18(2), 50–57. http://healthadmin.jbpub.com/mhc/readings/chapter%2001/hcm%2018-2.p50-57.pdf
Kyomen, H. H., & Gottlieb, G. L. (2005). Financial Issues in the Delivery of Geriatric Psychiatric Care, In. Sadock, B. J., & Sadock, V. A. (Ed), Kaplan’s and Sadock’s: Comprehensive Textbook of Psychiatry. Philadelphia: Lippincott Williams and Wilkins.
Sauber, R. S. (1997). Introduction to Managed Mental Healthy Care: Provider Survival, In. Sauber, R. S. (Ed), Managed Mental Health Care, Major Diagnostic and Treatment Approaches. Pennsylvania: Brunner/Mazel.
Tuft Managed Care Institute (1998). “A Brief History of Managed Care.” Retrieved November 16, 2007, from TMCI Web site: http://www.thci.org/downloads/BriefHist.pdf