MANAGED CARE

Managed Care



Managed Care

Introduction

Managed Care is a system of health care delivery. Managed Care focuses on cost of health care, the quality of care, and access to care. Managed health care includes various systems such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Points of Service (POS), and public managed programs such as Medicare and Medicaid.

HMO & PPO

Managed care uses various approaches to reach its goal of cost reduction for providing health care, but also to balance it with appropriate and excellent care. HMOs emphasize preventive care such as routine visits to the doctor's office, physical examinations, good care of babies and immunizations. Managed Care originated in 1929 with the start of a Farmers health organization. Health Maintenance Organizations (HMO) formed after World War II. Many of the initial programs were not-for-profit. During 1960-1985, HMO's become for-profit and grew in numbers. The federal HMO act of 1973 was a boost to the development. The HMO model is a network of physicians that provide services to members in that group or insurance plan. Today's managed care is a business that is complex and expected to continue to grow and change. HMO Physicians often limited in the care they prescribe due to the HMO's emphasis on minimizing costs. Many patients have registered in the indictment litigation to HMO relative lack of attention needed in order to reduce costs.

Employee Assistance Programs (EAP) may be offered by some employers as part of the insurance plan to assist employees through difficult personal situations. The goal is to help the employee through counseling or other services, and keep the issue from negatively impacting their work. The Preferred Provider Organizations (PPO) is a plan with a network of providers that have agreed contract to accept payment for all covered benefits under that organization. The preferred provider organization offering discounts to visitors who provide health care within their network. The private managed care models include HMOs and PPOs (Patricia, 2008).

Some advantages of PPO are:

1.You can choose doctors within or outside the PPO network.

2.You can choose specialists directly

3.You can make your own health care decisions.

4.You may be admitted to any hospital

Various Types Of Managed Care Organizations

Public managed care models include Federal Employees Health Benefits Program, Indian Health Service, Medicaid, Medicare, TRICARE (military), State Children's Health Insurance Program, and the Veteran's Administration. This paper will provide research and analysis of how different countries are applying health care management and their outcomes. The focus is on how it potentially applies to Managed Care improvements in America.

Health Care Reform policy has brought a great deal of discussion on how America can improve on our existing health care system. There are heated debates for and against reform. How other countries are managing health care for their nations, have brought up as examples of success and failures for proof of arguments. This paper will explore several models of health care in different countries. Analysis will attempt to determine which approach that combines the best of managed care versions based on this ...