Hcs/531evolution of Health Care

Topics: Health insurance, Managed care, Health care Pages: 6 (1448 words) Published: June 10, 2013
Evolution of Health Care

August 27, 2012
Russell Arezz III

Evolution of Health Care
Congress adopted the Health Maintenance Organization Act in 1973 that financed start-up costs for managed care companies and mandated firms with 25 employees or more to offer traditional health insurance. These provisions were terminate in 1995, but by this point health maintenance organizations and other managed care organizations were established in companies around the United States.

Identify the Subject

Managed Care is a form of health insurance that supplies inclusive medical care, which is established on a contract, paid in advance as opposed to traditional fee-for-service health insurance. Traditional health insurance pays a health care provider when services are needed. Managed -care plans pays a health care providers a fee monthly for every member of the plan, regardless of whether the member requires medical care or not.

There are three basic types of managed care organizations: health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans ("About Managed Care Health Plans," 2012). Managed care organizations contract a certain number of plans to providers in each service area.

Health maintenance organizations (HMOs) provide a simple supplemental health maintenance and medical services to members who pay in advance a fixed periodic fee is set without regard to the cost or type of services received ("Health Maintenance Organization Plans, " 2012).Plus diagnostic and treatment services, involving hospitalization, and surgery, an HMO often offers additional services, such as dental, mental, and eye care, and prescription drugs. The advantage of health maintenance organizations is this type of medical care annual premiums are less expensive the cost of care is distributed between the members. Preferred provider organizations (PPOs) physicians, health care providers of all classifications, hospitals, and clinics sign contracts with the preferred provider organization system to provide care to its insured members. These medical providers accept the fee schedule and guidelines for its managed medical care ("Preferred Provider Organization Plans, " 2012). The advantage of preferred provider organization it gives the member has more flexibility of finding health care provider out-of-network, even though it is cost more out-of-pocket for the member.

Point of service plans (POS) offers individuals medical care, which is overseen by a doctor, so he or she is the members “point of service” ("Point of Service Plans, " 2012). These providers generally will refer the patient to other in-network provider if the patient needs to see a specialist. There is a broad base of physicians in the network, which usually covers a wide area. The advantage point of service plans is that each individual has independence to choose out-of-network providers than with a health maintenance organization. However, this independence will allow the member to have out-of-network provider, but it will be more expensive.

Changing the Delivery of Health Care

According to Ethics in Medicine “Managed care refers to a variety of techniques for influencing the clinical behavior of health care providers and/or patients, often by integrating the payment and delivery of health care. The overall aim of managed care is to place administrative control over cost of, quality of, or access to health care services in a specific population of covered enrollees.”

The healthcare sector has undergone a tremendous change. Managed care impact on health care has created incentive for providers whether they are servicing managed or non-managed care patients. Managed care is there to help regulate the way healthcare is delivered and its will cost. An important factor that helped insurance companies take root in American society was that the medical...
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