Managed Care

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:

• 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.

References:

Claxton, G., Rae, M., Panchal, N., Damico, A., & Lundy, J. (2012). Employer Health

Benefits Annual 2012 Survey. Retrieved from http://ehbs.kff.org/pdf/2012/

8345.pdf

Sekhri, N. K. (2000). Managed care: The US experience. Retrieved from http://www.

who.int/bulletin/archives/78%286%29830.pdf

Scutchfield F. D., Lee, J., & Patton, D. (1997). Managed care in the United States.

Journal of Public Health Medicine, 19(3), 251–254. Retrieved from http://

jpubhealth.oxfordjournals.org/content/19/3/251.full.pdf

Support your responses with examples.