Managed care programs are increasing with the goals of controlling health care costs and continuing to provide quality care. Question exists however, regarding the maintenance of quality assurance and discussion includes methods of improving
Over the past 50 years, managed care programs have existed such as the Kaiser Permanente Medical Care Program (California) and the Health Insurance Plan of New York City. These programs only affected a minority of patients and physicians, until the past six or seven years during which managed care has grown significantly. Rising costs of health care, particularly in industry, and the fact that approximately 15 percent of the United States population lacks health insurance, have provided stimulus for this growth; health care expenditures account for over 14 percent of the gross domestic product in the United States. Management of medical services is attempted through managed care. It is estimated that around 100 million individuals are now covered by a managed care plan and that 77 percent of employers offer a managed care program (Friedenberg, 1996; Sunshine & Evens, 1994; Quickel, 1996).
It is concluded that through managed care, we may obtain a universal health policy mandated by the states. If congress continues to move Medicaid and Medicare patients into HMOs and industry mandates managed care for employees, this leaves only the medically indigent as a remaining group which would probably be picked up by the states (Friedenberg, 1996).
By the end of 1994, approximately 60 percent of physicians joined at least one health maintenance organization (HMO); radiologists have the greatest participation. At the beginning of managed care, growth was greatest in preferred provider organizations (PPOs). Physicians in PPOs contract with networks and agree to provide services for discounted fees. Practice habits do not need to change and physicians have no incentive to limit patient ...