The Managed Care – Health System Example

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"The Managed Care" is an astonishing example of a paper on the health system.   The phrase ’ Managed Care (MC)’ includes programs that are proposed to decrease unnecessary Medicare costs through various techniques that comprise financial inducement for physicians as well as patients to choose less expensive forms of care. MC is a product of all stakeholder-based groups that consider themselves as symbolizing parts of the entire system. These stakeholder groups comprise hospital patients, clinicians, pharmaceutical organizations, and their overall management system (Liberman & Rotarius, 1999). These stakeholder groups encompass clinicians who had been blamed for agitating patients’ and inappropriately upcoding their processes.

Moreover, hospitals that had been ascribed of both overbilling for delivering services as well as providing and regularly paying daintily veiled charges for referrals with regards to patients. Also, pharmaceutical organizations that had been ascribed for setting medicine prices at such cost that enable them to earn huge marginal profit for them. Furthermore, patients who are supposed to submit regularly or knowingly permit the filling of deceitful Medicare claims in support of their fraudulent providers (Liberman & Rotarius, 1999). Historical Perspective After World War-II, there was a considerable shortage of hospital beds for treating the people who were affected as war casualties.

Subsequently, the Medicare program was started for making an extension of hospital beds to enhance healthcare priority and also to augment a better service level. From 1965, Medicare was recognized to be a law of the land and this legislation was required to be adhered to by each healthcare association. Before the commencement of Medicare facilities, the importance of providers was dual i. e. enhancing accessibility to Medicare services as well as increasing bed capacity.

In 1978, the first Medicare program happened in America. The main motive of this program was to organize an effective Medicare model. This program was initiated by various ‘ East Coast’ shipping companies that build up pre-paid services for their marine employees (Liberman & Rotarius, 1999). Current State of Managed Care in the US HealthCare System Presently, American healthcare delivers effective Medicare through a broken technique in which the financing situation is quite complicated. In 2006, the costs of American Medicare hugely raised and occupied 16% of the Gross Domestic Product (GDP) with a budget of more than US$2 trillion.

This Medicare expenditure is equivalent by two times of other developing nations’ expenditure and it is assumed that it may rise to US$3 trillion in the upcoming 10 years without any reform taking place. In the US, as of the year, 2008, per capita Medicare expenses were US$6,697, which is US$1,645 more than any other 13 peer nations and by 2012 it had been expected to increase to US$12,782. In 2006, Healthcare costs raised enormously which was encouraged by the advantage of newly established drug privatization (Zarbalian, 3 Mar.

2008). Potential Impact of Health Care Reform Initiatives on Managed Care in the US The potential impact of managed care remains still largely in the debate. Supporters argue that it has boosted efficiency, enhanced overall quality levels, and led to an effective understanding relationship among costs and quality. The US Medicare-related system faces serious issues of high cost, imbalanced treatment, limited admittance, and insufficient health protection. Even though these issues have continued for many decades and also different reforms have taken place, however, the overall impacts of improvement efforts have been only modest (Hirsch, Homer, McDonnell, & Milstein, n.d. ).

References

Hirsch, G., Homer, J., McDonnell, G., & Milstein, B. (n.d.). Achieving health care reform in the united states: toward a whole-system understanding. Retrieved from http://www.garybhirsch.com/consulting_files/F-health-reform-final.pdf

Liberman, A. & Rotarius, T. (1999). Managed Care Evolution—Where Did It Come from and Where Is It Going?. Health Care Manager 18(2), pp. 50-57.

Zarbalian, K. (3 Mar. 2008). The current state of the united states health care system and universal health care in other countries. Retrieved from http://www.umm.edu/imres/talks/ZarbalianManu-HealthCare.pdf

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