Managed care (Coursework Sample)
1. Discuss three major criticisms/drawbacks of managed care. 2. Explain the major features of a consumer-driven healthcare plan (CDHP). 3. Compare the difference between a managed care plan (HMO or PPO) and a CDHP plan in terms of choice of providers, covered benefit, and level of cost sharingsource..
Managed care has been an essential health management strategy in United States. The different models of managed care have helped to understand the relationship between quality and cost in healthcare provisions (Shortell, Gillies, & Anderson, 1994). However, managed care has some drawbacks. Critics of managed care have pointed out to the weak points of the systems, but the problem is identifying a better alternative than managed care. The first drawback of managed care the high cost of health care in the United States. Simonet (2005) states that managed care introduced the insurers as a key player in healthcare services. Insurance companies seek to increase their profits and thus healthcare premiums have been on the rise. Ginsburg (2005) notes that as the premiums increase, employers also increase the burden on employees by increasing cost sharing ratios to the disadvantage of the employee. This makes the general cost of healthcare to increase for all in the managed care plans.
Managed care is to blame for the high number of uninsured people in the United States. Simonet (2005) cites the US federal Census Bureau, which reported in 2001 that 42.1 million Americans do not have any insurance cover. This high rate of uninsured is on the rise because managed care benefits the employed in large organizations. This leaves out a big number of the self-employed and those on a part time employment. The premiums charged by insurance companies cannot allow for a small organization and individuals on low income to afford (Ji, & Liu, 2007).
The third drawback of managed care is a reduction in healthcare quality. In a study of how managed care has affected disease management in outpatient care, Baker, Bundorf and Daniel P. Kessler (2010) established that there is quality gap. Managed care has not been able to transform the quality of outpatient quality delivery. One of the reasons why managed care has failed to improve outpatient delivery qual...
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