Manged Care

The relationship between the government and the managed care industry has changed over the years by expanding the rules and regulations to cover a national and regional level rather than at a local level (Kongstvedt, 2007). When the HMO Act was introduced, the employers felt that employees would have no choice but to accept the coverage that was provided by the government and that frightened some employers because American consumers valued choice (Kongstvedt, 2007).

Managed care plans have attempted to control health care costs by affecting patterns of health care delivery. Managed care grew so unpopular by the late 1990s that most commentators began referring to a "managed care backlash. This public outraged was called " The Managed Care Backlash", which prompted legistration to pass a prudent lay-person rule which guarenteed payment for emregency services(Kongstvedt, 2007,p.14).Providers complained about the second-guessing of their clinical judgment, and argued that managed care undermined the doctor-patient relationship and quality of care. Consumers had negative feelings because of the requirement to obtain authorization to see specialists and denial of coverage for truly necessary medical care (Kongstvedt, 2007).Consumers expressed concern that managed care was restricting choices, limiting access to necessary medical care, and lowering quality. Consumers were also exceedingly skeptical about the use of direct financial incentives and utilization review. HMO and PPO plans have attracted a significant share of the insured population, many of whom have switched from traditional indemnity plans. In response, many of the traditional plans have begun to offer managed care options. These changes have spurred significant consolidation in the health insurance industry.

References

Kongstvedt, P. R. (Ed.). (2007). Essentials of managed health care (5th ed.) 

The transformation of the health care industry has raised a number of interesting and difficult...