Custom essays: Managed care

Managed care represents a certain variety of techniques that have an aim to reduce the cost in providing the health care and to improve its quality. Managed care is a whole system and its responsibility is to control the delivery of the health services and the financing to those who have a specific care plan. Richard Nixon was the first political leader who took significant steps in changing the American health care system into a for-profit model. And in 1973, Congress approved the Health Maintenance Organization Act that encouraged rapid growth of the first form of managed care – Health maintenance organizations.
As a fact, the main goals of the managed care are to deliver a high-quality care in an environment, which controls and manages the costs, to deliver the care that is appropriate and medically necessary for the current condition of the patient, to render the care by the most appropriate provider and in least- restrictive setting. Nowadays the managed care is spread all over the United States, but still has failed to control the medical costs and there is much controversy around the managed care itself.
The Managed Care Organization (MCO) is a type of insurance organization in the United States. There are two types of organizations with different models: the PPO (Preferred provider organization) and HMO (Health maintenance organization). HMO’s restrict health care is within a specific network (hospitals, doctors, etc.), whereas with a PPO is more expensive, it is possible to consult where people want. HMOs have become extremely popular since the Health Maintenance Organization Act of 1973, which notably requires firms employing more than 25 employees that offer them the opportunity to subscribe for free to an HMO. The HMOs seek to reduce the cost of health (general medicine). They offer health centers where consultations are direct and negotiate the cost of consultations and interventions with stakeholders.
Types of the managed care programs include Health Maintenance Organization (HMO), Independent Practice Association (IPA), Preferred Provider Organization (PPO) and Point of Service (POS), which have different characteristics and features. The impact of the managed care still remains debated, as some say that it has increased its efficiency, and that fact helped to better understand the relation between the quality and costs. There are also arguments considering the facts of no direct correlation between the quality of the care and its cost. Critics also say that managed care had an unsuccessful health policy and the costs only increased, which led to the impact of health reform initiatives on managed care.
In 1990s there was a decline in a managed care, as the relationships between plans and health care providers were deteriorating. In the second half of 1990s the situation required changes in plans and in traditional approaches. The rise of the consumer driven health care has begun in 2002-2003, as in late 1990s there was a massive campaign highlighting the health care to consumers with the help of newspapers, television and later internet. The efforts as a result, were successful, as they were made directly to the users of health care. Greater involvement in a health care led to a new type of insurance in the U.S. – the consumer driven health plan. Media involvement and all these mechanisms completed the changes that were initiated by the decline of the managed care. Consumer drivel health plans were designed to reflect the main goals of the managed care and the development of healthful behaviors. The certain development of informational infrastructure has become an integral part of the implementation of consumer health care plans.