Bhs 450 Module 3 Ca

Module 3 CA

BHS450: Health Care Delivery Systems

The United States National Library of Medicine defines “Managed care” as an intended way to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). http://www.nlm.nih.gov/medlineplus/managedcare.html

Overall the idea is to negotiate a set price for certain services and they are agreed upon by the provider and by the payer. Seems like a government contact “Built by the Lowest Bidder” type of scheme. It’s more like a business now rather than providing the best care to the patient. The main four players that are involved in this whole process are the Patient (Consumer), the physician (Provider), the insurance (payer), and the HMO/PPO.

Wikipedia mentions that managed care was started back in 1973 when Congress passed the Health Maintenance Organizational Act under President Richard Nixon. Dr. Ellwood was a key player in this movement to change the system into a profit machine. The overall idea was to manage health care costs, but in turn it literally came apart when no one was there to regulate it.

The current state of managed healthcare in the United States is getting better. Patients are now getting more involved in the process. Ethics are still going to be one of biggest contributing factors facing all managed healthcare. Do you only do what’s needed or do you treat the patient? Questions will be asked among every...