Sample Anthropology Term Paper on Managed Care

Managed Care

Managed care is a system that infuses finances and the delivery of apposite care using an elaborate set of services. In its essence, managed care aims at achieving a twofold purpose of controlling health cost while at the same time delivering and managing quality health care. From its inception in the 60s, managed care has had a great impact in the evolution of healthcare provision (Dorsey, 1995). The significance of managed care goes beyond the twofold purpose to being a significant element of the health care structure.

At the center of managed care is provision of quality healthcare at reasonable cost. Before the inception of managed care, however, clinicians and medical practitioners worked towards provision of healthcare with little regard to cost (Navarro & Cahill, 2009). Doctors would therefore provide more healthcare with more fees collected for the services provided. With the advent of managed care, however, it is now imperative within the healthcare system for consideration of both necessity and cost in the delivery of healthcare.

Managed care has additionally been contributory in changing the process of health care provision. While this boils down to the reduction of health care cost, it has also impacted greatly on the processes involved in provision of health care. Therefore, through managed care, only the necessary medical processes are provided in managed care centers and other health care providing facilities. Moreover, managed care has influenced the provision of appropriate health services, largely out of necessity, and not according to laid-down procedures, which are sometimes unnecessary (Navarro & Cahill, 2009).

From the inception of managed care, both public and private health providers have been consistently working together with reference to managed care. Additionally, more of these providers have included other ranges of healthcare services to their insurance contracts, in addition to more products with a wide range of cost sharing options for families (Navarro & Cahill, 2009). However, with the varying degree of services, these providers have also excluded the latitude of the cover to exclude services, such as mental care, ancillary services among other conditions.

Managed care brings both gains and demerits to the health care system. Its significance is therefore hard to ignore based on the impact that it has so far had on the health care system. At its core, managed care hopes to solve two essential issues: the cost of health care and the disintegrated health care delivery system (Navarro & Cahill, 2009). So far, the system has been instrumental in the lessening of health care cost without derailing the value of health care services provided. The most important and significant principle of managed care is its cost management. Thus, while traditional indemnity gives the physician a free reign on the provision of services, given their lack of financial risk, managed care defines the benefits and services, giving incentive to the physician and the patient for adherence to policy procedures while using resources in a cost-effective manner (Navarro & Cahill, 2009).

Another great significance of managed care is the ability to offer an integrated payment and health care provision system, with the inclusion of both preventive and harmonized chronic care for subscribers. The significance of this integrated system is the ability to not only process covered claims, but also monitor the health care experience, and where necessary coordinated care. Such is therefore the organization and significance of managed care in quality care provision and bringing down the cost of health care.

 

References

Dorsey, J. L. (1995). Evolution of Managed Health Care. Bulletin of the New York Academy of Medicine, 77 (2), 595-603

Navarro, R. P. & Cahill, J. A. (2009). Role of Managed Care in the U.S. Healthcare System. Jones and Bartlett Publishers