Managed Care in America, Its Pros and Cons

Introduction

Managed care has become the fundamental network of the provision of treatment in the US since its implementation. Managed-care plans in the United States encompass local pharmacies to offer patients easy accessibility to economies of scale. Since medicines are bought in bulk to help with required care, the costs incurred by consumers at the counter may be decreased without affecting the profits gained by the providers. Moreover, there are often discounts offered to offer help to low-income people or patients without insurance. It has become significantly affordable to handle prescriptions with the managed care option (Moberg, 2018). Although managed care is currently nearly ubiquitous in the United States, it has also drawn controversy since it has had mixed outcomes in its objective of controlling health care quality and costs.

Background

Managed care in America depicts a group of practices meant to decrease the cost of the delivery of care and offer medical insurance, in addition to the improvement of the quality of care. A few decades ago, around 1990, attempting to transfer one’s medical information to different providers in America was extremely difficult. For the lucky patients, their doctors permitted them to have a copy of their files presented to the new health professional that they desired to see. The majority of patients just proceeded to the new office and provided details to the best of their understanding (Schafer, Galante, & Shafrin, 2017). Since there are now managed care plans that employ electronic health records, it has become simpler to transfer the required medical details from one health professional to the other. What is required is only the necessary authorization to make sure that every person who should be informed about the progress has access to the necessary information.

Despite its benefits, managed care has been criticized for its lack of patient confidentiality. With managed care becoming the point of significance for the healthcare system, there is an increasingly high risk that privacy concerns will arise in the course of controlling the information regarding every patient. Despite the implementation of policies that restrict access to patients’ data to an as-required basis, a high number of people translate to increased chances of sharing hence privacy violation (Schafer et al., 2017). This is because the moment a patient’s data is reviewed severally, there is no assurance that the information will remain confidential.

Challenges and Problems Associated

It is indubitable that quality and effective medical attention in the US is failing attributable to managed care. The healthcare system has become an expensive and overbearing field that is difficult to easily access for families which are neither living in poverty nor are they reasonably rich (Zeiger et al., 2016). Patients in the United States are dying at a young age, obtain insufficient care the moment they see the physician and encounter more limitations than other countries across the globe when attempting to secure specialist coverage. Such challenges and problems have resulted in the US healthcare system’s high dissatisfaction rate.

Review of the Literature

To some extent, managed care networks in the US assist in reducing the cost of medical treatment. The objective of a managed care plan is to decrease the costs that families incur the moment they access medical services by as much as practicable. Additionally, managed care provides a degree of emphasis to uphold the quality of health care that is available to every patient who needs it (Yeung et al., 2017). This benefit is made possible by the network of health professionals who can provide referrals to particular physicians to address conditions that occur. When families remain within their network, health care services are usually offered at a discount.

Managed care networks provide instantaneous healthcare resolutions for patients and families. In some countries, patients may be required to wait for more than one month to see a health professional regarding their condition. For such healthcare systems in other parts of the world, diseases that are not life-threatening might have even longer waits to bear. On the contrary, managed care networks in the US have the benefit of enabling quick access to physicians when the need arises (Willie, 2017). Regardless of the high-cost patients may be required to incur to access such services, they can visit health professionals of their choice with the confidence of obtaining advanced services for their conditions.

Schafer et al. (2017) affirm that manage care has assisted in keeping members of the family together. Quality health care services abound when patients and health professionals establish close relationships. Such practices make it easy for the caregiver to establish potential medical problems before patients even recognize that they might be a risk to their health. When such relationships are not formed, health providers might not have access to every bit of information necessary to realize a proper diagnosis. Under regular conditions, the managed care plans in the United States make it possible for all the members of a family to be attended by the same physician. This decreases the possibility of vital appointments being skipped.

Patients have a reasonable guarantee of treatment under the managed care system. Though the managed care approach may be viewed as a universal healthcare alternative, it may be more precise to portray it as a technique of access that permits patients to obtain a convinced degree of quality. Although medical outcomes are purely unpredictable, services provided by physicians and other caregivers are completely in their control (Willie, 2017). Managed care provides an approach of accessing providers who have particular accreditations that assist in the determination of what is leading to an adverse health condition and formulation of an effective treatment approach to assist in tackling the situation.

Despite their numerous benefits, managed care networks have their drawbacks too. For example, Yeung et al. (2017) assert that they turn patients into more commodities than individuals. A quick glance at the profit margins for health institutions in the US gives proof of this potential demerit. In 2012 alone, approximately 5,000 health facilities of all levels operated in the US (Yeung et al., 2017). It was established that the hospitals made a cumulative profit of more than 64 billion dollars for that year, which represented a 20% rise from what they posted in 2011. This was created partly by a 10% rise in outpatient costs, in addition to the average profit for every inpatient bed at the health facilities, which was more than 80 thousand dollars in 2012. To address the increasing cost of care, managed care should not continue to encourage such profits.

There is a need to reduce the cost of care since one patient may require multiple visits in an effort to receive full treatment. In a situation where patients go to a general practitioner for the treatment of a sore elbow, they may be required to cater for the costs of x-ray service, magnetic resonance imaging, or perhaps a computerized tomography scan. A radiologist will then assess the images before presenting a possible diagnosis to the physician, after which follow-up appointments such as casting and physical therapy occur (Yeung et al., 2017). Every service provided to the patient has its specific charge with no guarantee that full recovery will be realized.

Challenges/Problems Analysis

Under the managed care in America, an average family is required to pay about 1,000 dollars more for the healthcare provided to each member per year than a similar household in Canada or Europe. This signifies that a couple with three children can anticipate paying $5,000 less for the same health care provided in the US than they would incur if they resided in a different country (Yeung et al., 2017). This is worsened by other underlying challenges such as problems of insufficient care, poor quality, and lack of confidentiality in managed care networks. Moreover, managed care usually extends the wait time for routine conditions. Even in cases where hospitals have emergency appointments open for crucial health problems, it might take weeks before patients see their doctor. This is why the debate regarding the advantages and disadvantages of managed care has continually gained momentum in America. Regardless of the existence of whistles of socialism across the Internet every time alternatives are proposed, the truth is that the healthcare system in the US is wanting, and something requires to be done to improve it.

Recommend Solutions

For effective solutions to the problems facing managed care in America to be realized, consumers should be required to have responsible alternatives with considerable protection for low-income families. Patients should be given inexpensive fee-for-service access plans or be required to pay the full amount in capped premiums with net amount. There is a need for tax-free employer payments to be established at the rate of efficient health plans with the government subsidizing expensive procedures (Yeung et al., 2017). Moreover, the government should set regulations that check the cost of treatment for each service provided in a medical facility over and above, increasing the number of health providers to ensure that patients receive the required care promptly. These proposed solutions will give consumers personal and appreciated reasons for involvement in an effective and economical medical plan.

Implementation of Solutions

The government and ministry of health should increase awareness of the proposed solutions to make employers, workers, and health institutions comprehend the potential gains of competition and profitability while treasuring immeasurable benefits of quality and affordable health care. This will easily attract activists, voters, and representatives in the legislature to pass laws that enforce necessary changes for lasting and guaranteed solutions (Gordon et al., 2018).

Summary/Conclusion

Managed-care plans have become essential networks in the provision of treatment in America since their implementation. Despite managed care being almost ubiquitous in the US, it has also attracted debate since it has had its pros and cons. It has been condemned for lack of patient privacy and being expensive. Patients in America are dying at a young age, receive inadequate care, and have more restrictions than other nations around the world. For effective solutions, consumers should be given affordable fee-for-service health plans or capped premiums. The government should subsidize expensive procedures, set laws that regulate the cost of treatment for each service offered, and increase the number of caregivers to make sure that patients obtain the necessary treatment promptly.

References

Gordon, S. H., Gadbois, E. A., Shield, R. R., Vivier, P. M., Ndumele, C. D., & Trivedi, A. N. (2018). Qualitative perspectives of primary care providers who treat Medicaid managed care patients. BMC Health Services Research, 18(1), 728-735. Web.

Moberg, K. (2018). The role of managed care professionals and pharmacists in combating opioid abuse. The American Journal of Managed Care, 24(10), 215-223. Web.

Schafer, J., Galante, D., & Shafrin, J. (2017). Value tools in managed care decision making: Current hurdles and future opportunities. Journal of Managed Care & Specialty Pharmacy, 23(6), 21-27. Web.

Willie, M. M. (2017). On the role of managed care and management of chronic diseases. Medical & Clinical Reviews, 3(3), 11-16. Web.

Yeung, K., Suh, K., Basu, A., Garrison, L. P., Bansal, A., & Carlson, J. J. (2017). Paying for cures: How can we afford it? Managed care pharmacy stakeholder perceptions of policy options to address affordability of prescription drugs. Journal of Managed Care & Specialty Pharmacy, 23(10), 1084-1090. Web.

Zeiger, R. S., Schatz, M., Dalal, A. A., Qian, L., Chen, W., Ngor, E. W.,… Kawatkar, A. A. (2016). Utilization and costs of severe uncontrolled asthma in a managed-care setting. The Journal of Allergy and Clinical Immunology: In Practice, 4(1), 120-129. Web.