Managed care programs are increasing in number with the goals of controlling health care costs and continuing to provide quality care. Questions exist, however, regarding the maintenance of quality assurance. The issue of managed care and care quality is examined in this research.
Managed Care and the Evolving Health Care Environment
Changing social structures are leading to evolving approaches to the delivery of health care. The roles of the various professional providers of health care also are in a state of transition. Societal changes also are occurring that impact the ethical bases of the functioning of health care delivery systems. Managed care is an evolving approach to the delivery of health care that affects each of these other factors (MacStravic, 1996).
Reform of the health care system in the United States is a volatile issue. Costs are the primary concern of funding providers, while a continuation of the opportunity to earn profits is the primary concern of the health insurance industry, and increased access to health care services is the primary concern of social activists. Managed care has been proposed as the concept that can satisfy each of these three groups (Hahn & Flood, 1995).
Managed care is a program type that proponents claim ensures appropriate care for a wide range of medical treatments through the application of techniques such as pre-admission certification, concurrent review, case management, utilization rules, and price limits (Gales, 1996). Opponents contend that managed care is a deceitful sham designed to maximize profits and minimize care (Merwin & Fox, 1992). The truth about managed care likely lies at some point along this continuum of opinion. The intent of the application of the managed care concept is to balance access to services, service quality, and the cost of services in relation to health care (Goldfield, 1994).
Managed care is becoming the "backbone of health care de...