Managed Care refers to techniques used by organizations to reduce the cost of health care facilities and to improve its quality. There are several managed care contracting terms which need to be understood before they are used in the campaign. Few of these are listed below and explained.
- Balance Billing: The patient is expected to pay the physician for any charges over and above the insurance coverage. It is important for people to understand this in order to avoid confusions.
- Dependent: All individuals apart from the employees themselves, who qualify to benefit from a health care plan. This increases the costs to the organization providing health care facilities.
- Duplication of benefits: Individuals who are covered by more than one health plan. This must be taken into account when approving an individual’s health care plan because it would mean an added cost otherwise.
- Exclusions: Eliminating those medical conditions from the health plan which may not be necessary. It ensures that people do not claim for unwanted health insurance for instance for a cosmetic surgery.
- Network: This includes all those organizations which qualify as health providers. It validates whether the health plan claim is coming from a genuine source or not.
- Provider: Individuals or organizations which are healthcare suppliers. This ensures nobody is violating laws and practicing illegally under the managed care label.
- Second opinion: The patient is asked to refer more than one advice before a medical procedure is conducted. This allows for the individual to gain knowledge and understand what he/she would undergo.
- Subscriber: This is the person responsible for premium payments either through the employer or directly to the health plan. It is important to know who is responsible for contributing towards the health plan.
A decade ago people had a negative impression about managed care and they were under the impression that it was a compromise by organizations over their health care since, for-profit organizations aimed to minimize costs. However, due to widespread criticisms and political pressure insurance companies began to offer more comprehensive plans for applicants to choose from. On the other hand, managed care plans were able to control the ever increasing health care costs of unnecessary hospitalizations and medical procedures. Even though these plans led to a public outcry but it was for the betterment of the economy as a whole. However, the inclusion of out-of-network options has quieted down the public and over 135 million people who have health care insurance are covered by some form of a managed care plan.
The future of managed care largely depends upon the enthusiasts to keep supporting this cause, but the trends show that people who initially supported this plan are now losing the excitement. Added to this, the pressure from Congress to curb healthcare also goes against those who are in favor of managed care. Packages suiting the needs of the people will have to be tailor-made as medical advancement will put upward pressure upon the costs of this policy. Moreover, physician-led managed care will need to be emphasized upon if the public policy wants to preserve professional norms.
However, managed care can prove to be beneficial for the state as well as patients if it is managed well and constant improvements are made to adapt to the requirements of the applicants.
References
Fuchs, V. R. (n.d.). Policy Brief. The Future of Managed Care. Retrieved December 5, 2013, from http://www.stanford.edu/group/siepr/cgi-bin/siepr/?q=system/files/shared/pubs/papers/briefs/policybrief_dec00.pdf
Health First Accept Insurances. (n.d.). Health First Accept Insurances. Retrieved December 5, 2013, from http://www.health-first.org/about_us/mgd_care_terms.cfm
National Council on Disability. (n.d.). Appendix B. A Brief History of Managed Care:. Retrieved December 5, 2013, from http://www.ncd.gov/publications/2013/20130315/20130513_AppendixB
