Managed care is a term used to portray a range of techniques intended to reduce the cost of provision of health care benefits and to improve the quality of care for the organizations that offer these health services. It is also a term that describes a system of financing and delivering quality health care to listed individuals and health providers who have adopted and subscribed to managed care techniques and concepts. It is highly credited with controlling health care cost by forcing the providers to review and discount their rates while at the same time improve on the quality of their health services. Managed care’s major objective is to make health care more affordable. Individuals who subscribe to this program pay a set fee regardless of their health status or medical needs. People with various chronic diseases especially value these benefits because they are assured of regular treatment and quality health maintenance.
In the past, health care insurance was offered by the traditional fee-for service insurers. You paid your medical expenses to the health provider then later submitted a claim to your insurer for reimbursement of some or all of the expenses incurred. One had the privilege of visiting the doctor as many times as they wanted and get reimbursement all along. These uncontrolled claims lead the insurance companies to experience a high loss ratio, which caused them to significantly increase health plan premiums. Due to this, the industry needed to lower and monitor its costs, managed care became rather popular. Managed care has been growing rapidly and changing trend since its inception in the late 1980’s. In fact, the increasingly vital role managed care companies play in our health systems has probably had the greatest impact. However, it still faces many challenges due to new trends emerging daily in our societies. Discussed below are some of the lasts trends that have taken center stage in the growth of managed care.
Search for more Flexible Managed Care Planning.
There has been a recent trend among the employed population towards active participation in more flexible managed care packages, including Preferred Provider Organization (PPO) and Point of service arrangements (POS). These two arrangements have been more preferred to the traditional Health maintenance Organisations (HMO) because they allow consumers a more expansive selection of health care providers. According to an annual survey conducted by Kaiser Family employer health benefits 2012 (Guzik,2013,p.404), PPOs now enjoy a whopping 64% of all the covered workers as compared to HMOs which enjoy only 19% of the total covered populace. This has proven to be an increasing trend since the year 2005 it was adopted by only 36% of the covered employed population. Flexible managed care arrangements like PPO and POS are mostly praised for their open-access plans. With the open-access plan, one does not need approval from their primary physician when they want to seek the services of other health specialist, as was the case with the traditional HMO arrangement. This trend in managed care where the covered individuals feel more affiliated to flexible health arrangements show that the people were dissatisfied with the previous rein of Health Managed Organizations (HMO), which exercised a tight choice of providers and access to health specialists.
Increasing rate of uninsured individuals
The high cost of health insurance coverage and the ever-increasing rate of unemployment is making a good number of people less interested in healthcare insurance. Health care providers have resolved on cutting back on benefits due to the increased health care costs by the above named drivers of the economy. In the recent years, there have been an increasing proportion of the United States populace that is either uninsured or underinsured. This affects adults in the range of 19 and 64 years where the percentage of uninsured citizens rose from a low of 38% in 2008 to a high of 47% in 2012. The biggest and fastest-growing group of this uninsured population is mostly composed of youths aged 34 years and younger. Many managed health care Companies have rolled out effective plans aimed at helping this group of uninsured or underinsured individuals acquire medical cover. They aim to achieve this by introduction of youth friendly products that are appealing to this segment of the population, this includes medical benefits such as whitening of teeth and gym membership discounts in addition to the normal medical cover. Most of these products have gained favor with the youth and work on improving and encouraging preventive care and regular checkups. How this trend would affect children still remains open to speculation. However, on the positive side, the trend towards less stiff health plans should be able to increase provider preference and easy access to services of specialists.
Increase in ‘For-Profit’ Health Care Systems.
Recently, there have been a rapid growth in For-profit health care arrangements, this has resulted to great impact on the trend of managed care industry. These are health care providers who are primarily concerned about making profit. Previously, Non-profit healthcare providers have been always committed to delivering community health care benefits for instance to the uninsured, rolling out regular programs for people with special needs and general voluntary community health projects. These non-profit managed care systems are almost becoming extinct and replaced by a more business and profit oriented mode of health care system. In 1995, only a meager 18% of the total HMO’s represented for-profit organization but since the acceptance of PPO’s, the percentage has sharply shot up to 84% for the PPOs (Kongstvedt,2001,p.818) that are in the healthcare industry as for profit businesses. The main concern about this kind of system of healthcare organization is that since they have put efforts to deliver health care to both its shareholders and patients, some of the expected benefits of managed care may be ignored as efforts to maximize on profits is prioritized.
In conclusion, the above-discussed recent trends in health care industry will always continue to influence managed care largely. Unfortunately, there is no perfect way or method to fix these issues except probably through some education. The above plans have stripped out managed care’s intended purpose because of the high deductibles. Among many more suggestions on reducing the cost of managed care insurance services, employer wellness programs are arguably the most capable way. However, managed care plan should be commended for its attempt to cut on the cost of healthcare. Doctors that are in this plan are encouraged to minimize the number of referrals they order. In addition, health providers who appear to be overcharging patients are at times dropped from the plan. Despite the challenges, we are still hopeful that managed care will continue to campaign for affordable and quality health care.
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