Three Main criticisms/Drawbacks of Managed Care
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Three Main criticisms/Drawbacks of Managed Care
The managed care system is a healthcare plan that has widely been embraced in the United States of America. However, the policy and legislations support the system of care; there is major criticism about it. The major criticism is on the formulation, contract, effectiveness, economic motivations, and utilizations ranging from the patient, provider, sponsor and system factors. However, there exists a definition of contexts in the practice including the medical necessity; there are still hitches as much as benefits pursued (Matcha, 2000). There is a feeling that the economic issues have brought about the need to control healthcare to save costs.
The healthcare cost have escalated in the recent past, and that with the economic regressions, governments are initiating measures to control the situation. With the increasing demand of care and the shooting costs, there needs to be responsibility and accountability for the care provided (Cimasi, 2013). The expenditure on healthcare has to prevent wastage and avoid duplication of services to patients, but at the same time, quality has to be maintained. With the focus on efficiency to produce much at less cost, there may be pressure on practitioners to do much to patients in less time at reduced cost. The monetary interest of the care providers may compromise their ethical concern and ignoring patient concerns in a bid to push for more benefits in terms of incentives (Practice Issues Dominate Managed Care Help Line, 2003).
Another concern is the service provision in comparison to other persons in different care plans. Two patients with same conditions may receive separate attention in that one in managed care may not receive the amount of care as such of a counterpart in fee for service plan (Matcha, 2000). It is not a factor to base on however since the aspect differs across organizations while they outdo other care plans in most sectors. Finally, managed care has a drawback in addressing access to healthcare for those without insurance or in remote areas where the system may not be feasible, thus much needs to be done to make adjustments.
Major Features of a Consumer-Driven Healthcare Plan (CDHP)
This healthcare plan is where the focus is on motivating patients to take an active role in seeking healthcare and become better consumers through cost shifting initiatives. This plan is employer initiated to encourage employees to take a role in healthcare purchasing process through its special designed features. The program runs under a purchase of a higher deductible plan combined with a health savings account or health reimbursement arrangement (Cimasi, 2013). Therefore, this is a significant feature of the CDHP as it offers a method for the allowable type of payment in combination with another program that will either reimburse the care scenario through the employer or self. The combination methods are commonly tax-advantage accounts managed by anemployee or the employer depending on the type to aid in paying deductibles.
Another feature of this program is its shift of the cost of healthcare from employers to workers,and the healthcare service seekers hold the primary decisions in deciding their healthcare they receive (Helmchen, Kaestner, & Sasso, 2009). In this case, therefore, the patients control costs and would go for cheaper treatment options that are affordable. Finally, another key feature of this plan is the seamless options of care providers that the healthcare seekers have to choose. There exist free variables that offer ground for competition of providers since patients can sway in selecting options. Lower prices too can be a characteristic of the system with improved care and higher quality that will likely attract more persons.
Difference between MCOP and CDHP Plan
The consumer-driven healthcare plan presents the user with the opportunity to choose the available providers on where to seek medical attention (Helmchen, Kaestner, & Sasso, 2009). The consumer will compare the procedures, the quality, and the process but most likely the cost of care. For this reason, therefore, the plan have the capability of inducing both appropriate and inappropriate medical procedures depending on the knowledge of the client. In a health management organization, however, the beneficiaries are allocated to a primary physician who acts as a gatekeeper for all the services for such person. The primary physicians carry out the general care and handle recommending hospitalization or refer the patient to a specialist.
The payment method is another significant difference. In managed care, the patient is covered entirely for services sought under the recommended network of providers. If one chooses to seek attention outside the system, the individual will be responsible for such cost with the insurer only sometimes settling little part of the total cost. In consumer-driven plan, the consumer is capable of seeking medical attention from any service providers and compensation will still be made. In managed care, the beneficiary pays aminimal amount in terms of cost sharing compared to consumer-driven plan where the payment is done through deductibles. The monthly premiums for the management care plans are normally constant whereas the premium for the CDHP will depend on the level of deductibles, with higher deductibles attracting fewer premiums.
Feature(s) Enabling ACOs to Control Cost and Improve Quality of Care
Accountable care organizations were created as the desire for improved quality of care at minimal costs was realized to be of importance (Cimasi, 2013). The healthcare system was undergoing a rapid change, and the costs and demand were escalating at a higher speed. To control quality, the United States created policies and regulations to encourage care providers to embrace the ACOs and meet the benchmarks set. The incentives were established to ensure that more facilities and providers adopted the plan and joined advocacy for reduced cost while offering quality care through set procedures such as elimination of duplicate service. The measures the government has put in place and the legislations passed ensure that the players in health sector change their structures to fit that of the recommended ACO. The emergence of new trends and equipment also contributes to the drive for the establishment of the accountable care as a focus on quality and reduced wastage (Practice Issues Dominate Managed Care, 2003).
The plan to reward the care providers and providing institutions for a network of accountable care organization through the established benchmarks is a significant feature (Cimasi, 2013). Embracing the benchmark and complying enables the management of cost while improving quality. The reward on the cost controlling practitioners and facilities with proper evident quality is also a drive for such organizations to focus on appropriate quality services other than duplicate costly procedures (Metz, 2014). The structure of the organization also ensures the coordination of services offered with a focus on reducing wastage while improving care, as service delivery receives appropriate monitoring and control. There are continued performance measures and monitoring that will ensure proper quality of services offered by the organizations. The system provides that the providers only undertake appropriate procedures in the best ways possible at minimal cost while maintaining quality to avoid penalties while attract incentives.