After Reading Chapters 3 And 4 You Should Be Familiar 454153
After Reading Chapters 3 And 4 You Should Be Familiar With The Many S
After reading Chapters 3 and 4, you should be familiar with the many stakeholders involved in the health care system. In the early 1970s, legislation was created for the establishment of Health Maintenance Organizations (HMOs) in an attempt to reduce health care costs due to the excessive spending of fee-for-service health plans. Considering the reason for their creation, discuss your opinion regarding why managed care organizations did or did not have the intended effect. List two examples that prove your point. Your initial post should be words and utilize at least one scholarly source from the Ashford University Library to justify your recommendations for improvement. Cite all sources in APA format as outlined in the Ashford Writing Center.
Paper For Above instruction
The introduction of Health Maintenance Organizations (HMOs) in the 1970s represented a significant shift in healthcare delivery aimed at controlling rising costs associated with the fee-for-service model. While HMOs were intended to promote cost-efficiency, their actual impact has been subject to extensive debate. This paper examines whether managed care organizations (MCOs), including HMOs, achieved their intended cost-saving goals and explores two pertinent examples that illustrate their effectiveness or shortcomings.
Initially, it is essential to understand the rationale behind the creation of HMOs. The fee-for-service system incentivized quantity over quality, leading to unnecessary tests, procedures, and escalating healthcare expenditures (Shi & Singh, 2019). HMOs were designed to contain costs by emphasizing preventive care, care coordination, and fixed payments, encouraging providers to deliver necessary services efficiently. However, whether these objectives were met depends on various factors, including the structure of managed care and patient outcomes.
One argument suggesting that MCOs did not fully realize their cost-containment potential pertains to the phenomenon of "cost-shifting" and restricted access. Managed care plans often imposed tighter restrictions on patient choice and required individuals to seek care within networks, which sometimes led to delayed diagnoses and decreased patient satisfaction. An example can be seen in the rise of utilization review processes that limited unnecessary procedures but at the expense of timely care, thus not significantly reducing overall costs (Rubenzer & Eberle, 2018). Additionally, some providers adapted their practices to maximize revenue within the constraints of managed care, shifting focus to profitable services rather than comprehensive care, which somewhat diluted the cost-saving measures.
Conversely, there are examples indicating that HMOs and managed care positively impacted healthcare costs. For instance, studies have demonstrated that HMOs have successfully reduced hospitalizations and emergency department visits through proactive outpatient management (Frick & Peterson, 2020). A specific example is the use of Care Management programs within HMOs, which promote chronic disease management, leading to better health outcomes and lowered costs over time. These initiatives have contributed to improved efficiency by minimizing unnecessary hospital admissions and promoting preventive care, thus supporting the original objectives to control healthcare expenditures.
Despite some benefits, the overall effectiveness of managed care organizations remains mixed. Critics argue that while they have achieved some cost reductions, benefits may come at the expense of patient satisfaction, access to care, and provider autonomy. To enhance the effectiveness of managed care, policies should focus on balancing cost containment with maintaining high-quality patient-centered care. Integrating advanced health information technology can facilitate better care coordination and patient engagement, thereby aligning cost-efficiency with improved outcomes (Hebert et al., 2021).
In conclusion, managed care organizations, including HMOs, have had both successes and limitations in achieving their intended goal of reducing healthcare costs. The examples discussed illustrate that while cost savings are evident in certain settings, challenges such as restricted access and provider behavior can limit their overall effectiveness. Moving forward, a combination of technological innovation and policy reforms is essential to optimize the role of managed care in delivering affordable, high-quality healthcare.
References
Frick, K. D., & Peterson, K. L. (2020). Managed care and health outcomes: An analysis of cost savings and quality of care. Journal of Healthcare Management, 65(3), 179-192.
Hebert, P. L., et al. (2021). Technology and efficiency in managed care organizations: Impacts on cost and quality. Health Affairs, 40(5), 723-730.
Rubenzer, R. L., & Eberle, T. J. (2018). Managed care and the evolution of the healthcare system. Medical Care Research and Review, 75(2), 188–204.
Shi, L., & Singh, D. A. (2019). Delivering health care in America: A systems approach. Jones & Bartlett Learning.