Managed Care
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There many current forms of managed care being implemented in the United States. In most managed care plans patients pay an established fee for health care services that are delivered by a group of physicians and other services dictated by the plan. There are three main kinds of managed care plans: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) and Point of Service (POS) Plans. In addition to these forms of managed care, both Medicaid and Medicare represent managed care programs in the U.S. Medicaid is a jointly funded federal and state health insurance program that provides health care services to low income families and individuals. Medicare is a federal health insurance program for those over 65 years of age and older. Medicare encompasses hospital insurance for which people typically do not have to pay and medical insurance for which most people pay a monthly fee. Regardless of which of these current managed care programs we examine in the U.S., we find inadequacy, ineptitude, excess and spiraling costs. Medicare was a state-of-the-art program when it was ushered in under the Johnson Administration in 1965. However, it has not kept pace with advances in medicine, medical technology nor the threat imposed from a rapidly aging American demographic. As many seniors are overwhelmed by rising prescription costs and as the entire system’s budget is threatened by an ag
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legislators about the lack of quality care in many programs. Many argue that the confusing and elaborate delivery system is in need of major reform in American health care systems. Current delivery models vary widely depending on geography, relative market penetration of managed care, population density, and a variety of other factors (Taylor 34). So, too, models encompass everything from loose affiliations of solo practitioners to independent practice associations, hospitals, and management service organizations. Supply and demands issues in such an arrangement further complicate the economics involved and threaten to erode consumer choice and quality of care. As Taylor explains, “There is currently a power struggle over the premium dollars as physicians, hospitals, health plans, and payer-led groups attempt to align themselves with the central managers of health care costs, which in today’s capitation arrangements are typically PCPs” (39).
Too few dollars remain after such struggles to be invested into primary care capacity. One of the most significant aspects of managed care programs is the selection of a primary care physician. Such a primary care doctor works closely with patients to assist them in the majority of the
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Approximate Word count = 1522
Approximate Pages = 6 (250 words per page)
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