Health Insurance and Managed Care

MANAGED CARE

Introduction

Managed care is a system that has changed US healthcare substantially and has introduced many new variables into the healthcare environment to which it is still in a period of adjustment . This report will look at these variables in terms of factors that show positive directions for the future , even though some critics say that the system of managed care is run not by concern for the customer , but by the bottom line of profits . It is therefore not a community healthcare organization necessarily , but a consumer one

. The report will partly measure the future using ideals of community healthcare . Community healthcare has many advantages in that it seeks to support the whole of a society whereas consumer health care is often about the bottom line and is dictated by supply and demand . It makes price , availability accessibility and the quality of medical care a function of free-market determination or negotiation . It grants the doctor or the managed care organization a presumed proprietary right over medical knowledge . The justice of the business contract requires the physician or the organization to deliver nothing more than is owed by the conditions of the contract with the plan (Pellegrino , 2001 . Consumer health care also brings benefits of increased technology , although community implementation is sometimes problematic

Accessibility is the key issue in the debate over healthcare and managed care . Managed care hopes to influence the rules of supply and demand in consumer care , and

Medicare provide programs that increase accessibility for the poor and elderly . But many

think that healthcare organizations need to reach out to the community in terms of

educational programs that seek to foster the health of the community as a whole , rather

than treat ailments in a specialized manner and have it end at that Accessibility , as well

as education , is an important goal for the model healthcare program in terms of

conceptual framework

Problem definition

There are more variables that concern present problems with managed care . Generally managed care does not provide enough funding for enforcement , so that quality of care can be compromised in a repeated cycle in some facilities without any sort of punitive action being taken to make sure that the licensure procedure is reflecting an accurate cognizance of its codes . People are afraid of big government , so they do not want private providers who are accredited to be subject to an undue amount of scrutiny , and this also places a significant obstacle in the way of ensuring that quality-of-life issues are important enough to garner action-oriented incentives from the establishment . Taking a facility 's license is a long and involved procedure requiring significant court time and legal expenses , and this is also seen as prohibitive by many states that do not want to face lengthy appeals processes . This issue often has weighted resonance in political circles because it is very important to large segments of the population . In 1996 , it was estimated that 100 million Americans were in managed health plans (National...