In Certain Situations Managed Health Care Offers The Most Ef ✓ Solved

In certain situations managed health care offers the most ef

In certain situations managed health care offers the most effective solution. For example when a patient needs surgery, this program may offer cost savings. Surgeries are usually expensive due to their technicality, risky nature and lots of commitment on the part of the physician. Managed care ensures that the patient pays a lower cost as it establishes cost sharing incentives for outpatient surgery. The major benefit is that of obtaining quality service at a reduced cost.

Similarly, there is improved care for patients with complicated conditions. Case management refers to a tool for offering services to those with chronic medical conditions, this includes cost effective telephone interventions to monitor medical services or offer planning to inpatient facilities. A scenario in which effective case management is used is in the mental health where case management helps a client to receive disability benefits or housing assistance. The benefits of this program are integrating services to the needs of individuals with long term problems for example mental patients. Other benefits arise from the fact that its pro-active and community based.

In addition, case management reduces the utilization of hospital based services. In some cases, case management is said to be done poorly for example in the case that the health and well being of the carer is compromised. Scenarios where the carer contracts the chronic disease like tuberculosis, HIV or is abused by the patient, case management is said to have been done poorly. I would manage these circumstances by assessment of the cases, care planning and care coordination to ensure that case management is effective. This will reduce cases where the carer well being is compromised and will increase quality of care.

Paper For Above Instructions

Managed health care, when effectively managed, can provide significant benefits to patients and health care systems alike. The structure of managed care fundamentally aims at controlling costs while ensuring quality care through various mechanisms, including case management. In this paper, we will explore the effectiveness of managed health care, particularly in surgical cases and the management of chronic conditions.

Cost-Effectiveness of Managed Health Care in Surgical Procedures

One prominent advantage of managed health care is its ability to mitigate the costs associated with surgeries. Surgical procedures can be financially burdensome due to their complexity and the risks involved. Through managed care arrangements, patients often face lower out-of-pocket expenses for surgeries. Managed care organizations (MCOs) achieve this through negotiated rates with healthcare providers, which helps control costs and pass the savings onto patients (Miller & Luft, 1997).

In addition to cost savings, managed care systems frequently employ cost-sharing incentives that encourage patients to opt for outpatient surgeries rather than inpatient ones. Outpatient surgeries typically require less extensive facilities and shorter recovery times, allowing for more efficient use of resources (Scott, 2000). This can lead to better overall care, as patients are less likely to experience complications that can arise from prolonged hospital stays.

Improving Care for Patients with Complicated Conditions

Managed care is also effective in addressing the needs of patients with complicated health conditions. Effective case management is integral in this context. Case management involves coordinating care for patients, particularly those with chronic ailments, by integrating services that address their unique medical and social needs (Ross, Curry & Goodwin, 2011). This integration can include arranging for mental health services, rehabilitation, or vocational assistance.

For instance, in mental health care, case managers play a vital role in ensuring that clients receive necessary support, including accessing disability benefits or housing assistance (Ross et al., 2011). This tailored approach not only improves quality of care but also aids in reducing the overall burden on emergency services and inpatient facilities, contributing to long-term cost savings and better patient outcomes.

Challenges in Case Management

Despite its advantages, case management can be poorly executed in certain scenarios. One significant concern arises when the health and wellbeing of caregivers are compromised due to their exposure to chronic diseases from patients or high-stress environments. Instances where caregivers develop conditions such as tuberculosis or HIV, or when subjected to patient abuse, highlight failures in case management protocols (Scott, 2000).

Such scenarios emphasize the importance of safeguarding the well-being of care coordinators and ensuring they have the resources and support needed to perform their duties effectively. This can involve providing regular training, mental health resources, and ensuring a safe working environment to reduce both physical and psychological risks.

Strategies for Effective Case Management

Managing the complexities of case management requires proactive strategies to enhance care delivery while protecting caregivers. Assessment of cases is crucial; ensuring that every patient's needs are thoroughly evaluated can help avoid potential pitfalls (Miller & Luft, 1997). Care planning should be individualized, integrating the necessary medical, psychological, and social services that cater to the specific needs of chronic condition patients.

Moreover, care coordination must be seamless, facilitating communication among various healthcare providers involved in a patient's care. This enhances the continuity of care and ensures that patients are not lost to the system. By employing these strategies, managed care systems can maximize their efficacy, ensuring that both patients and caregivers benefit (Miller & Luft, 1997).

Conclusion

Managed health care provides an effective solution in various situations, particularly regarding surgical interventions and the management of chronic conditions. While challenges exist, proactive measures in case management can enhance the quality of care. The integration of services tailored to individual patient needs helps ensure that treatment is both effective and efficient, leading to better health outcomes and reduced costs for patients.

References

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