In the United States, managed care is becoming an increasingly popular method of administering healthcare. It influences the clinical behavior of providers, as it combines the payment and delivery of healthcare into a single system, the purpose of which is to control the cost, quality, and access of healthcare services for a single bracket of health plan enrollees (Scutchfield, Lee, & Patton, 1997).
Yet, managed care often evokes strong or negative reactions from healthcare providers because they are paid a fixed amount for treating their patients, regardless of the actual cost, which may influence their level of efficiency. This can challenge the relationships between doctors and patients (Claxton, Rae, Panchal, Damico, & Lundy, 2012; Sekhri, 2000).
Research managed care’s inception and study some examples. Be sure to investigate the perspectives about managed care from the vantage of both healthcare providers and patients. You can use the following keywords for your research—United States managed care, history of managed care, and managed care timeline.
Based on your research, answer the following questions in a 8- to 10-page Microsoft Word document: INCLUDE REFERENCES
- What are the positive and negative aspects of managed care? Analyze the benefits and the risks for both providers and patients, and how providers should choose among managed care contracts. Conclude with your analysis and recommendations for managed care health plans. Your response should include answers to the following questions:
- Summarize the history of when, how, and why managed care was developed.
- Define and discuss each type of managed care organization (MCO)—health maintenance organization (HMO), preferred provider organization (PPO), and point of sale (POS).
- Explain the positive and negative aspects, respectively, of managed care organization from the provider’s point of view—a physician and a healthcare facility—and from a patient’s point of view.
- Explain the three types of incentives for providers for efficiency in the delivery of healthcare services. Explain who bears the financial risk—the provider, the patient, or the managed care organization.
- Offer your recommendations, to accept or decline, for patients considering managed care health plans, with your rationale for each.
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Managed Care Nursing Assignment Help
Introduction:Managed care is a healthcare delivery system that aims to control the cost, quality, and access of healthcare services for a single bracket of health plan enrollees in the United States. Managed care refers to a system where the payment and delivery of healthcare are combined into a single system. In recent years, the use of managed care in healthcare has seen an increase in popularity. However, it also evokes strong or negative reactions from healthcare providers because they are paid a fixed amount for treating their patients, regardless of the actual cost, which may influence their level of efficiency. This paper aims to summarize the history of managed care and provide an analysis of the benefits and risks of managed care plans for healthcare providers and patients.
What are the positive and negative aspects of managed care?
The positive aspects of managed care include cost-effective services, quality care, and preventative services. By using managed care, healthcare providers can reduce their costs and increase their revenue. Also, managed care emphasizes preventative care, which helps to save money by avoiding expensive hospital stays.
On the other hand, the negative aspects of managed care include restricted access to doctors and hospitals, limited choices in healthcare providers, and the potential for substandard care. Managed care plans limit the healthcare providers that patients can see, which may lead to the potential for substandard care.
Define and discuss each type of managed care organization (MCO)
Health Maintenance Organization (HMO) is a prepaid health plan that requires patients to use only its doctor and hospitals for their healthcare needs.
Preferred Provider Organization (PPO) is a type of health insurance plan that contracts with healthcare providers to create a network of healthcare providers.
Point of Service (POS) is a type of managed care plan that combines features of HMOs and PPOs.
Explain the positive and negative aspects, respectively, of managed care organization from the provider’s point of view—a physician and a healthcare facility—and from a patient’s point of view.
From a physician’s point of view, managed care enables them to expand their patient base and negotiate agreements with healthcare plans. On the other hand, it also puts pressure on them to provide cost-effective medical care, which may lead them to prioritize profit over care.
From a patient’s point of view, managed care provides them with cost-effective care and access to preventative services. However, it also limits their choices in healthcare providers and may pose as a barrier to receiving the appropriate care.
Explain the three types of incentives for providers for efficiency in the delivery of healthcare services. Explain who bears the financial risk—the provider, the patient, or the managed care organization.
The three types of incentives for providers are fee-for-service (FFS), capitation, and pay-for-performance (P4P). In FFS, providers are generally paid for the quantity of services provided. In capitation, providers are paid a fixed amount per patient per month for providing comprehensive care. In P4P, providers are rewarded or penalized based on their performance.
The financial risk is borne by managed care organizations.
Offer your recommendations, to accept or decline, for patients considering managed care health plans, with your rationale for each.
Patients should consider managed care health plans based on their individual healthcare needs and financial situation. In general, managed care plans are cost-effective and provide preventative services. However, they may limit their choices in healthcare providers and pose as a barrier to receiving the appropriate care. Patients should carefully read through the terms of managed care plans before joining and consult their healthcare providers for advice.
