Managed_Care

Managed Care Dolores G. Quintanilla HCA/230 August 21, 2011 University of Phoenix Managed Care More than 50 million residents of the United States do not have health insurance. Over 10 million of that amount is children. Low-income households are three times as likely to be uninsured compared to households with income above $75,000. An estimated three-quarter of people who have insurance are in personal bankruptcy because of medical problems, my mother falls into that percentage. According to data from the census bureau, of the 50 million Americans without health insurance, more than 10 million are non-citizens of the United States. Medicare provides health insurance coverage to over 43 million Americans over age 65. Medicaid provides insurance coverage to 53 million people of all ages. However, there are many Americans without coverage. That should not be happening in America or to Americans. Managed health care is the predominant form of health care in the United States. The providers, whether it is a health care maintenance organization (HMOs), preferred provider organizations (PPOs), or point-of-service plans (POS), all come with various pros and cons. From a consumers perspective the pros and cons are somewhat balanced. An advantage for members of a health care maintenance organization (HMOs) is the preventive care provided such as yearly checkups. Also, lower monthly premiums, and co-payments for prescriptions. Additionally, managed health care insurance organizations create large groups of members, which lower costs for everyone. A disadvantage in managed care insurance programs is that people lose individuality and become numbers in an unfriendly system of insurance policies. In addition to that, the patient does not choose his or her doctor the choice is the responsibility of the insurance provider. The managed care plan provides a list of “approved” providers who have through quality checks with the insurance provider. In addition, to keep financial burdens down, HMOs limit doctor visits and limit specialized care, medical information becomes less confidential, and managed care premiums have risen as much as 20% a year. A caregiver’s pro perspective to managed care is that he or she has guaranteed patients, especially if the caregiver provides care to all employees of a huge company. The con is that providers are capped on how much is paid out for medical services rendered. If not managed correctly, he or she may lose money because of a managed care plan. Many insurance providers provide a discount card for medical services rendered, prescriptions, dental visits, and eyeglasses. However, they are just that discounts the cardholder does not save much money and not all health care providers accept the card. If I were a health care provider, I would choose managed care plans and accept discount cards. This would mean a steady flow of patients who would keep the facility in business. Managed care would help cut some of the expenses of maintaining the facility and staff members. In addition, it would also give more time with the patient because caregivers are sharing the workloads among other caregivers. The economy is struggling at the present time, and so are many businesses it would be practical and beneficial for all involved in managed care.