Abstract Healthcare in the United States has a long history; from the traveling physician who provided services in private homes and charity organizations, to government programs such as Medicare and Medicaid that proceeded hospital construction, and the relatively recent trend of managedhealthcare. Along the way, innovation and competition facilitated new healthcare technologies and services that offered numerous approaches to prevention, treatment, and management of diseases. In a bold new healthcare policy, integration and collaboration between the public and private sectors of healthcare is not only an option, but a necessity in providing the most efficient and sound healthcare services and options. This paper examines healthcare in the U.S. from a historical and current perspective and concludes by introducing a new model of managedhealthcare utilizing a systems approach.
Table of Contents
Introduction
Historical Examination of HealthCare Public Sector HealthCare in the USA
Private Sector HealthCare in the USA
Types of ManagedCare Organizations
HMO Models
The Merging of Public and Private HealthCare Models
A New Universal ManagedHealthCare Model
Conclusions
References
Appendices
From the Paper "The managed health care industry did slow the growth in health care spending. Moreover, by extending coverage to services provided in an outpatient setting, it reversed the artificial preference for in-patient care that was created by indemnity insurance benefit designs. By focusing on clinical variability in physician practices, the shift to managed care forced the elimination of some unnecessary care. It also provided a stabilizing force to professional fees and institutional charges."
Abstract In this article, the writer presents a discussion of various aspects of managedhealthcare and evaluates their validity and success rate. The writer explores cost containment, health prevention, health population focus and other elements of managedhealthcare to determine their probable success or failure. The writer notes that whereas years ago, managedhealthcare was a rarity in the healthcare and insurance industry, it is now moving toward becoming the most commonly system used for healthcare delivery. The writer concludes that the world of managedhealthcare is expanding and with that expansion comes improvements.
Outline:
Introduction
Health Prevention Methods
Cost Containment Strategies
Quality Improvement
Population Health Focus
Conclusion
From the Paper "As America's health care costs continue to skyrocket and the public demands changes managed health care has continued to expand its services nationwide. Whereas years ago managed health care was a rarity in the health care and insurance industry, it is now moving toward becoming the most commonly system used for health care delivery. Several decades ago, managed health care was the brunt of many problems. Those who were using it through their insurance plan believed that they were getting substandard care and there were many complaints lodged about having to wait months for appointments and once the patient was at the doctor he or she failed to order appropriate tests to determine the cause of the patient's symptoms.
As time moved forward however, insurance companies began to depend more on managed care providers and with those changes came improvements in the system. Currently managed health care offers a wide variety of health care needs and provides tests, diagnostic and curative measures to their patients, but one of the most significant things that managed health care offers is preventative maintenance. The field of managed health care is a numbers game. The system is counting on more people paying premiums and not needing to be treated for anything than patients who have medical issues to be dealt with. One of the things that managed care organizations do to prevent the rising cost of medical care is provide solid and consistent preventative care options to encourage patients to get check ups and work to treat any problems that arise while they are still at their beginning stages. "
Abstract This paper defined managedcare as the effort to coordinate, rationalize, and channel the use of services to achieve desired access, service and outcomes while controlling costs. It then explains that risk-based managedcare are organizations which provide or contract to provide healthcare in broad/specified areas for a defined population for a fixed, prepaid price. Various strategies are used to control costs and this is accomplished by offering a broad range of services at least the areas of hospitalization, physician care, various types of ancillary care and/or medications. The paper explains the importance of presenting the benefits in advance, along with payments expected from the covered individual or member, so that the person can make an educated decision.
From the Paper "Health care expenses frequently are too expensive for the average individual to pay as they go, but are suitable for health insurance coverage. Managed care provides either the service directly or contracts to provide them. This differs from conventional health insurance, where the insurer would underwrite the coverage, but not become involved the delivery of services. Managed care providers take a financial risk for part or all of the cost of service. There are three levels of risk. First, full risk whereby the provider accepts all of the financial risk for providing services, as well as all profits and losses. Secondly, partial risks where the provider accepts a portion of the risk. Third, no direct risk to the provider, but receive incentives to control cost. The last one is found in various case-managed primary care arrangements."
Abstract This paper explains that managedhealthcare influences customer service and healthcare delivery by providing a blueprint in which the customer is more valued than ever in this dynamic environment. The author points out that, although the system has drawn criticism from both those working inside the healthcare industry and this industry's consumers, it is generally accepted that the increased competition, combined with cost-control initiatives, will result in better quality care for the consumer. The paper states that the main obstacles in the managedcare system are Medicare HMOs, which dropped many older, unhealthy individuals from coverage to remain cost-effective, and other HMOs, which have adopted a marketing stance that appeals primarily to healthy individuals and denies those that are unhealthy the option of managedcare.
Table of Content
History of Provider
Current Role of Provider
Current Provider Characteristics
From the Paper "In the current environment, a widespread change in healthcare that occurred in the late twentieth century and is still getting settled today in terms of permanency and consistency, further divides political debate on the issue of national healthcare. "Professional dominance in healthcare delivery had long favored the supply side of the market equation. With the growth of managed care, the balance has swung towards the demand side. This change has happened not just in the private sector but in the public sector as well". The current system is a managed care system that expands healthcare options for many individuals, but critics state that this system still leaves too many people out in the cold when it comes to healthcare."
Abstract This paper presents and evaluates some of the changes currently taking place in today's healthcare environment. In particular, it focuses on managedcare initiatives and health insurance. The writer recognizes that some of the changes occurring with healthcare reform are positive, such as cutting costs and promoting preventive medicine. However, these changes are not without concern. The paper concludes by stating that the problems arising from healthcare reform need to be understood so that the needs of the patients are put first.
From the Paper "Several years ago, health care reform was a hot political topic with President Bill Clinton's proposals to revolutionize medical health insurance. Even though his proposals didn't become law, sweeping changes are occurring within the health care system, particularly in regards to managed care health insurance and the reengineering of the hospital. The goals of these changes are to cut medical costs, make the delivery of health care more efficient, and to promote preventive medicine, health, and primary care. While these changes are positive in many ways, they are also creating concerns among both the health care consumer and provider. These changes must be managed to insure that high quality care remains at the forefront of medical care."
Tags:health, care, managed, care, health, insurance, hospitals, patients, health, care, providers
Abstract This paper explores all of the myriad and complex causes of the high cost in today's healthcare environment and recommends changes that would be the most likely to positively impact change. Charts and graphs are used to help illustrate important points.
Introduction
Prescription Drugs
Medical Devices and Medical Advances
Rising Provider Expenses
General Inflation
Government Mandates and Regulations
Government Programs and Tax Laws
Increased Consumer Demand
Lack of Consumerism
Litigation and Risk Management Fraud and Abuse
ManagedCare System
Conclusion
From the Paper "Priority Health also believes that the United States government is at fault for not imposing price controls on pharmaceutical products as do most other industrialized nations, thus leading to drugs costs that are as much as one hundred percent higher in this country. Additionally, the United States government imposes regulations for drug distribution and sales that make drugs less readily available and more expensive than in other countries. Also, government granted patents protect drug for up to seventeen years, limiting competition and driving up prices."
Tags:health, care, spending, managed, care, health, insurance, employers, premium
Abstract This nine page undergraduate paper examines future aspects of healthcare from the perspective of healthcare administrators and managers. The writer notes that it is evident that challenges must be overcome, despite the numerous problems presented by historical, social, ethical, technological, and financial factors. The writer points out that at the present time, the healthcare system in the United States is confronting rising costs and undiminished expectations, and the system is in crisis. Further, the writer discusses that controversial issues of socialized medicine, cost shifting, and budget deficits will have to be addressed if needed reforms of the American healthcare system are to be implemented.
From the Paper "In examining future aspects of health care from the perspective of health care administrators and managers, it is evident that they must overcome the numerous challenges presented by historical, social, ethical, technological, and financial factors. At the present time, the health care system in the United States is confronting rising costs and undiminished expectations, and the system is in crisis. Controversial issues of socialized medicine, cost shifting, and budget deficits will have to be addressed if needed reforms of the American health care system are to be implemented. But reforming health care in the United States is contentious because it will affect the level of services and involve tens of millions of beneficiaries and taxpayers."
Abstract This paper examines communication issues facing today's healthcaremanagers working in a collaborative team with adolescent patients. The paper describes the components of a collaborative team, and details the responsibilities of individual members.
Abstract This paper reviews the requirements for healthcare finance and accounting. The paper describes the financial environment within which healthcare financial administrators perform their functions, such as accounting, financial planning, budgeting and financial control. The paper also examines the effect of growth of the managedcare sector.
Abstract This paper presents an assessment of the economics of healthcare costs. The paper argues that the problem is a complex maze of related issues such as funding mechanisms, delivery structures and individual responsibility. Additionally, the paper recommends a national healthcare system for managing family healthcare costs that is based on universal access to healthcare.
From the Paper "Health care economics is entering another state of turmoil in the United States as the moderating effects of the managed care concept on increasing health care costs appears to have run its course. The Congress and state governments believed the promises of managed care proponents that managed care would lower health care costs dramatically and are resisting rapid increases in health care costs. Managed care companies are responding by dropping governmentally-funded patient groups including Medicare and Medicaid raising charges to..."
Abstract The paper discusses how the shortage of healthcare and poorer standards of quality have tested the ability of society to provide the medical support that the population needs. The paper relates that the present standard of care has raised concerns among healthcare providers and patients regarding the implementation of new methods of improving the standard of care. This paper provides an overview of the healthcare industry's standard of care and suggests concepts that hospital management and healthcare providers could utilize to improve the quality of healthcare overall.
Outline:
Introduction
Standard of Care Conclusion
From the Paper "In the medical profession, the business process perspective refers to internal processes. Metrics based on this perspective allow the managers to know how well their business is running, and whether its products and services conform to patient's requirements. These metrics have to be carefully designed by those who know these processes most intimately, usually includes the identification of mission-oriented processes, and support processes. Mission-oriented processes are the special functions of government offices, whereas the support processes are more repetitive, and easier to benchmark and measure using generic metrics. The patient perspective can be improved by enhancing the quality of care, and perhaps by offering additional services needed by the physicians that are not currently addressed or not stressed enough. The final perspective, financing healthcare, involves timely and accurate funding where the implementation of a corporate database would ideally centralize the majority of the processing of the data in addition to automating the processing of financial data. A hospital or health care provider could successfully implement this perspective by including additional metrics, such as other types of financial related data, such as risk-assessment and cost-benefit data."
Abstract This paper examines the strategic management process in healthcare organizations in the present age. The paper reveals the various external factors which impact upon the organizational decisions of an organization and then notes the internal dynamics which also influence such decision making. It also stresses the need for excellent communication amongst all levels of the organizational hierarchy. The author acknowledges how external stimuli are forever causing adaptations or reassessments by the organization of what it is doing, why it is doing what it is doing, and how what it is doing might be improved upon.
From the Paper "There can be little doubt that the strategic management process of a sophisticated health care organization is daunting in its complexity and astonishing in its breadth. The following paper will briefly review the environmental factors which shape strategic thinking in such organizations and it will also examine the internal factors which must come into play in any such organization if it is to achieve success in a competitive, demanding sector. With the aforementioned in mind, it is to a discussion of the strategic management process in health care organizations that this paper now turns. Drawing upon exhibit 1.4 in our course textbook, a few things become immediately apparent. The first of these is that the external environment shapes internal decision-making; no organizational move is made en vacuo. For instance, the general environment - consisting of government, business organizations, educational institutions ..."
Abstract My research compares and contrasts the healthcare system of the United States and that of the United Arab Emirates (UAE). Without a doubt, the most noticeable difference between the two health systems is that the United States system works under the managedcare model while the UAE system follows that used in one way or another by most of the developed nations: the universal healthcare system.
Abstract This paper discusses the issue of rising healthcare costs in the United States, and relates the issue to the government, business, and healthcare industries. The paper further looks into these organization's roles in halting rising healthcare costs, and discusses professional opinions in relation to the matter. The addition of technology and its affects on healthcare are also discussed.
From the Paper "In the United States there are many poor, aging, and young who have traditionally been without health insurance due to the rising costs associated with care. When society considers those entities that should play a significant role in reducing health care costs the organizational elements of government, industry, and health care providers them selves are logical considerations. Yet, while the United States patiently waits for some type of health care cost relief there does not appear to be any notable action being taken to reduce these costs. During the December 2002 online discussion posted on NewsHour, with Jim Lehrer, the issue of health care costs was discussed in relation to insurance providers, hospitals, and health care workers. Lehrer spoke with many professionals in these organizations, and discovered that there are primary causes for the rise in health care costs in the United States. "
Abstract This paper examines how the question of whether healthcare is a right or a privilege is highly controversial. It looks at how some feel that in a wealthy country such as the U.S.A., all citizens should have access to free healthcare, as a basic human right and how others believe that, like all commodities, healthcare should be paid for. The paper argues that healthcare is a basic human right that should be available to all U.S. citizens, regardless of whether they are able to pay for it.
