Term Project 3: 5-Page Essay On Managed Care In America

Term Project 3 5 Page Essay Essay On Managed Care In America

Term Project 3 5 Page Essay Essay On Managed Care In America

The finished document has to be no less than five pages long including a cover and reference pages. APA format must be followed all the time. The project must be submitted through Turnitin.com for similarity. The receipt has to be blue or green color. Other colors will indicate higher percent of similarity and may jeopardize the grade.

Paper For Above instruction

Introduction

Managed care has become a cornerstone of the American healthcare system, shaping how care is delivered, accessed, and financed. The essay explores the advantages and disadvantages of managed care, comparing it with healthcare systems in other countries. It also incorporates insights from the documentary "SICKO" by Michael Moore, which critiques the American healthcare system's shortcomings and offers a perspective on healthcare access and quality.

Overview of Managed Care in America

Managed care refers to a system of health management that seeks to improve the quality and efficiency of healthcare delivery through coordinated services, cost containment, and quality oversight. Common models include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans. These frameworks aim to reduce unnecessary services, control costs, and improve health outcomes by emphasizing preventive care and primary care coordination (Long, 2020).

Advantages of Managed Care

One significant benefit of managed care is cost control. By negotiating with providers and emphasizing preventive care, managed care organizations help reduce unnecessary treatments and hospitalizations, leading to lower overall healthcare costs for insurers and patients (Cohen & Rouleau, 2019). Additionally, coordinated care facilitates better management of chronic diseases, potentially improving patient outcomes and quality of life (Davis et al., 2021). Managed care plans also promote regular screenings and preventive services, which can catch illnesses early and reduce treatment expenses over time (Bodenheimer & Smith, 2013).

Access to healthcare under managed care can improve as well, especially in systems that integrate primary care and specialty services. Patients often benefit from structured care pathways, ensuring timely appointments and follow-up (Fitzgerald et al., 2020). Moreover, preventive focus encourages healthier populations, consequently decreasing long-term disease burdens.

Disadvantages of Managed Care

However, managed care also presents notable drawbacks. Patients may experience restrictions on provider choice, as plans often have networks of preferred providers. This limitation can lead to dissatisfaction, especially if patients wish to see specialists outside their network (Smedley et al., 2003). Additionally, the emphasis on cost containment might sometimes compromise the quality of care; necessary treatments may be denied or delayed to save expenses, raising ethical concerns (Claxton et al., 2019).

The administrative complexity of managed care is another issue, resulting in bureaucratic hurdles that can delay care and frustrate patients and providers alike (Cohen & Rouleau, 2019). Furthermore, the focus on efficiency might lead to an under-provision of complex or personalized care, which can negatively impact patient outcomes, particularly for those with rare or complicated health conditions.

Comparison with Healthcare in Other Countries

Compared to other developed nations such as the United Kingdom, Canada, and Australia, the U.S. healthcare system, heavily reliant on managed care, exhibits marked differences. Countries with universal healthcare systems tend to prioritize equity and access, often providing healthcare services free at the point of care (OECD, 2022). For instance, Canada's publicly funded system guarantees access regardless of socioeconomic status, contrasting with the American model where insurance coverage significantly influences access to care.

In nations like the UK, under the National Health Service (NHS), healthcare is primarily funded through taxes, ensuring widespread access with less concern about direct costs at the point of service (Allin et al., 2022). In contrast, the U.S. system’s reliance on insurance-based managed care inherently leads to disparities in access, which the documentary "SICKO" highlights—many Americans lack coverage or face significant barriers to necessary healthcare.

While managed care aims to control costs, countries with universal systems often demonstrate better health outcomes and higher patient satisfaction levels without the extensive administrative overhead and provider restrictions characteristic of U.S. managed care systems (OECD, 2022). However, critics argue that some universal systems may suffer from rationing or longer wait times for certain procedures, a challenge the U.S. system attempts to mitigate through managed care networks.

Insights from "SICKO" Documentary

Michael Moore’s "SICKO" offers a stark critique of the American healthcare system, exposing how many individuals are denied care due to insurance policies, or face bankruptcy because of medical expenses. The documentary emphasizes the moral and ethical issues surrounding profit-driven healthcare, contrasting it with universal systems in other countries where healthcare is recognized as a right—not a privilege (Moore, 2007).

The film illustrates cases where insurance companies withhold approvals or deny coverage, leaving patients vulnerable, especially during critical health crises. It advocates for a shift towards a more equitable system modeled after countries with socialized medicine, highlighting the disparities created by managed care practices in the U.S. The documentary's perspective underscores the importance of examining not just cost efficiency but also ethical obligations to ensure access to necessary, life-saving healthcare.

Conclusion

Managed care in America offers notable benefits in terms of cost control, preventive care, and improved chronic disease management. However, it presents challenges related to restricted provider choice, potential compromises in care quality, administrative complexity, and disparities in access that raise ethical concerns. When comparing the U.S. system to other countries with universal healthcare models, it becomes evident that the American approach often sacrifices equity and broad access in favor of cost containment and efficiency.

Insights from "SICKO" further illuminate the moral implications of the current American healthcare system and underscore the need for reform. Achieving a healthcare system that balances cost, quality, access, and ethical responsibility remains a critical challenge for policymakers. To improve health outcomes and societal well-being, America might consider integrating the best aspects of managed care with the principles of universal access, potentially transforming healthcare into a fundamental right for all citizens.

References

  1. Allin, S., Cohen, J., & Marchildon, G. (2022). Canada’s universal healthcare system. BMJ, 377, e070031. https://doi.org/10.1136/bmj-2021-070031
  2. Bodenheimer, T., & Smith, M. (2013). Primary care: proposed solutions to the challenges facing America’s health care system. Health Affairs, 32(11), 1881-1887. https://doi.org/10.1377/hlthaff.2013.0494
  3. Claxton, G., Cox, C., & Rae, M. (2019). Understanding health care costs: Managed care and beyond. Journal of Health Economics, 67, 102223. https://doi.org/10.1016/j.jhealeco.2018.10.004
  4. Cohen, R. A., & Rouleau, J. (2019). Managed care: Balancing cost and quality. The New England Journal of Medicine, 381(14), 1344-1346. https://doi.org/10.1056/NEJMp1914120
  5. Davis, K., Staiger, D., & Auerbach, D. (2021). The future of health care delivery: Lessons from the COVID-19 pandemic. JAMA, 326(12), 1133-1134. https://doi.org/10.1001/jama.2021.15421
  6. Long, M. (2020). Managed care health insurance: Structure, purposes, and challenges. Journal of Health Administration Education, 37(2), 148-163.
  7. Moore, M. (2007). Sicko [Documentary film]. Michael Moore Productions.
  8. OECD. (2022). Health at a glance 2022: OECD indicators. OECD Publishing. https://doi.org/10.1787/4dd50c09-en
  9. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. National Academies Press.
  10. Fitzgerald, G., Kahn, J., & Hsia, R. (2020). Managed care and access to primary care: A review. Annals of Family Medicine, 18(3), 245-251. https://doi.org/10.1370/afm.2575

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