In past years there was a constant increase in the health related costs. The expenditure touched $2.3 trillion in United States in 2008 alone which was just $714 billion in the year 1990. The expenditure was eight times more in 2008 compared to 1980. It accounts to $7681 per capita expenditure spent by US health care in 2008.Adverse effects has been observed amongst citizens and government due to unprecedented rise of health care costs. Obviously, US government is spending less in economic growth and more on health care. Concerns were raised by citizens and businesses to implement health care reforms by the government. Managed care has been implemented in order to reduce the health care costs drastically but unfortunately the existing managed health care delivery systems never achieved the stipulated target of reducing the costs incurred due to health care.
The patients used to suffer continuously due to their limitation of services offered by the physician practice and the quality of care offered. This situation is due to ineffectively managed health care plans. Managed care deals with several methodologies which are focused to reduce the costs incurred whilst offering improved quality of care and health benefits for organizations and citizens. The primary goal is of this plans is to drastically reduce the health care costs. The physicians and patients needs to be offered incentives which make them easier to select among various options which are economical. Cost sharing by the beneficiary and medical necessity can be reviewed by the managed care programmes. The quality care due to health care plans is often questioned through critics and proponents.
Another evoluted version of the managed health care is integrated delivery system which comprises of providers selected by concerned managed care organizations who in turn offer services to its members. It is also having stringent standards whilst choosing appropriate providers. In addition to preventive care the delivery system provides incentives in financial forms for motivation of the enrolled members for their better health. At present, the managed care plans offers round the clock services to the enrolled members. There is an established network with physicians, health care providers and hospitals which will avoid independent practices. The network decides the fee to offer health services to the patients. The problem is that very less people were enrolled in the managed care programmes and in future there will be no chance of enrollment because of the conflict in ethical issues linked with managed care. The regulations issued by the government affects the managed care and other issues will affect on Medicare and Medicaid. Example of the ethical issues which affect the running of future of managed care is patient-physician relationship, freedom for physician and quality of care.
The health care system and payment system are integrated via managed care. The improvement of health care systems is to be required to effectively monitor the service offered. The physicians face lot of difficulty to offer their services with low cost medicines and within insufficient time frame. This system also offers nothing in terms of incentives and bonuses so a physician gets a rotten fruit all the time which they have spent in the managed health care centre. The permission to use right treatment and diagnosis is denied due to the condition that the less cost medicines and diagnostics should be used at the managed care organization. Hence, the physicians compromise with minimal treatment and diagnosis. The secondary factor which considerably affects the quality of care is the cost of the medicine which is being offered to the patients. Instead of enhancing the quality offered to the patients there is a steep decline in the quality due to the monetary benefits and penalties given to the concerned physicians. The poor quality of services offered to the patients let the new members to stay out of the managed health care delivery systems in future.
The patients would like to prefer a normal care instead of these ineffective managed health care systems. The health care providers sign a contract and strictly follow the guideline which dictates that less time and money should be spent on the patient and hence hinders the percapita services offered though enhancing productivity. In future the managed health care systems will be adversely affected due to the guidelines framed in their respective contracts. The overall care, patients care and physician services will be deteriorating in future because of inability to choose good managed care organization by the providers. This system has negative impact on hospitals, public and physicians since all the relationships were ill affected. Despite of the ethics the physicians are not allowed to discuss the problems with the patients freely.
The managed health care should be improved to enhance the quality of care offered to the citizens. They offer less space to the physicians to think about new methods in order to maintain the rules set. The main aim of the managed health care system is to reduce the costs but it has never attained its goal instead created several problems linked with ethical and human relations. It should ensure the balance between reducing cost and quality of care. The main ingredients which affects this system in future is the quality, provider, contacting, public, physicians, hospitals, cost containment, role of government regulations such as HIPPA and ERISA.
References
Burns, M.E., The University of Wisconsin. (2008).The prevalence and effects of Medicaid managed care for adults with disabilities. Proquest.
Ahi, L., and Singh, D.A. (2008).Delivering health care in America: systems approach. Jones and Barlett learning.
Rui,L.(2005).Impact of financial incentives on physician productivity in medical groups.University of California, Berkely.
Gervais, K.G. (1999).Ethical challenges in managed care,a case book.George town University Press.
