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Discussion Question #2

The growth of managed care that began in the 1980s was mainly driven by Health Maintenance Organizations (HMOs).  Prior to this time, doctors were still independent and payment was through fee-for-service (Zinner, 2009).  If not for physicians, the U.S. health care system may have very well been one of a nationalized, universal system.  It makes one ask the question whether this would have been better for America had this happened.  The reason to ask is because as a by-product of fighting this a universal health care system off, inflationary health care costs rose at astronomical rates in just 10 years of 117%, while the consumer price index rose 59% during the same period (Shi & Singh, 2017, p. 220).  HMOs set the stage for organized health care and reimbursement to physicians (2009).  Physicians began to feel like they were losing their once dominated field, because HMOs more or less forced them to work for organizations that ultimately reduced the cost of health care, and shifted focus to a preventive health care system.

A payment system called “capitation” was put in place that paid physicians a set fee that required them to treat all their patients from this amount.  This led to the term “managed care”, were not only physicians had to manage their patients within set financial limits, but made the patients (consumers) take care of themselves through “preventive medicine, consumer choice, and being accountable for one’s own health and health care” (Zinner, 2009).

Presently, approximately 95% of employees are enrolled in managed care plans, as compared to 27% in 1988 (Shi & Singh, 2017).  One would be hard pressed to locate employees who are enrolled in an employer-sponsored conventional plan.  This is probably by design since managed care is so popular, and dominates the health system’s market.

Managed care plans include many different varieties: there are HMOs, Preferred Provider Organizations (PPOs), and Point-of-Service (POS) plans.  There is a chart on page 230, of our class text, that summarizes the various plans, while listing at the very top of the chart the “main distinguishing factors.”  These are the type of providers, in or out of network, the method or delivery of services, and the payment an risk sharing component.

It seems the future of managed care will continue in the same direction as it is now.  Hospitals, providers, private offices, and other facilities will need to continue to consolidate or integrate forces.  Reimbursement payments will become tighter and stricter, and it will benefit everyone involved to work together as an integrated system to maximize profits, increase quality of care, maintain increased access to care, while keeping costs at a minimum.

There will always be those that abuse the health care system.  The more efficient it becomes — the more affordable it becomes, the more frequently individuals will visit their physicians more often than they should, which will have a negative impact as this drives up prices.  Until we “Come…¦return to the Lord” (Hosea 6:1a, HCSB), we will need to work on improving our health care system.  “For He has torn us, and He will heal us; He has wounded us, and He will bind up our wounds” (Hosea 6:1b).  What a day that will be when we will experience no more sickness!

 

References

AARP.  (2017).  AARP.com.  Managed care plans.  Retrieved on August 8, 2017 from https://advantages.aarp.org/en/healthcare-insurance/healthcare-tools-resources/understanding-health-insurance/managed-care-plans.html

Shi, L., Singh, D.  (2017).  Essentials of the U.S. health care system.  (4th ed.)  Managed care and integrated systems.  (p. 220).  Burlington, MA: Jones & Bartlett Learning.

 

Zinner, M. J., & Loughlin, K. R. (2009). The evolution of health care in america. Urologic Clinics of North America, 36(1), 1-10.doi:10.1016/j.ucl.2008.08.005