History Of Managed Care

Submitted By helpme1080
Words: 1536
Pages: 7

There are approximately over 308.7 million people living in the United States of America and each one of them have a need for access to affordable and accessible health coverage and services. Within the last 40 years the outlook and cost of health care coverage and services has dramatically changed, forever altering the manner in which health care was previously looked at. Since the early 1980’s fast growing enrollment in managed care health insurance plans has changed the health insurance market in the United States. Managed care was basically nonexistent in most markets 4 decades ago; managed care health plans covered 63 percent of the nation’s employee’s by 1994. Managed care plans incorporate different features that allow the insured member options in the process care and the delivery of that care. Managed care plans contract lower prices from physicians and hospitals and attempt to conform the use of health care services by monitoring providers and changing the incentives for them. Health insurance providers that work under fee for service plans allow the members much more freedom of choice concerning doctors and treatment programs. Purchasers of indemnity plans pay a price for the amount of freedom they have with access to providers and that is with extremely higher rates. Many of today’s health insurance purchasers choose to purchase plans with a managed care insurance company. They usually rely on the expertise of the provider to support and facilitate their many medical treatments and needs. Health maintenance organizations also known as HMO’s, have proven to be the most chosen with managed care providers. There are other types of managed care plans which include PPO plan (preferred provider organization, POS (point of service) and managed indemnity plans. HMO’s are the most popular health insurance plans and mainly the most affordable. HMO’s have effectively reduced health care expenditures (Miller and Luft 1994; Manning et al. 1987; Luft 1981).
There was a time when managed care was viewed as the best form of coverage in efforts to help assist employee, physicians and hospitals with maintaining quality health care, while controlling the ever rising cost of medical care in the United States.
There are so many factors that have affected the cost of health care coverage over the course of the last four decades. These many changes bring about new ideas and the way consumers are serviced when utilizing their health care coverage. One of the factors is the vastly increasing enrollment in managed care health care insurance plans. Managed care health insurance plans can very much in most cases help relieve the increasing costs of effective medical coverage for individuals. Another main factor that has affected health care costs is the implementation of advanced new medical technologies. As many researchers and analysts have discovered, that there is direct connection between the advancement of medical technology and rising health care costs. Advancement in the medical field has been proven time and time again to be a key part of the increase of the cost of healthcare. Comparisons have shown the cost increase of health care in markets with greater managed care influence to be generally slower that of non-managed care health markets. There is another factor with the small selection of options that are available with physicians in small towns this is where patients have limited physicians to choose from. Does this lower this specific populations the quality of care for the provider’s members or does this cut off services for members that are critically ill in these areas? These types of rural areas are where managed care needs to expand. Managed care continues to affect not just members in the work force but also it affects disabled population, the elderly community, and young children covered under Medicaid. There is a major struggle to find a solution to all the concerns that are related to