Managed Care & Qualaity Assurance

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

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kmails the mental health therapist into providing fast, cheap treatment. Similar outcomes may be anticipated in all health care fields. Waitzkin (1994) drew a parallel between the planning-programming-budget system (PPBS) concept applied by public sector organizations and the concept of managed competition (managed care) that has been proposed as a basis for national health care reform. Waitzkin (1994) described the application of the PPBS concept to the military health care system in the 1960s as a form of managed care. The application of the PPBS concept to the delivery of military was a failed experiment. Waitzkin (1994) argued that, while the experience of the military health care system with PPBS raises warning flags for those who would make managed care the basis for national health care reform, the earlier experience does not ensure that managed care would be a failure as a basis for national health care reform. Waitzkin (1994) concluded that managed competition, or managed care, as a basis for national health care reform may lead American health care "down a path inconsistent with the aspirations of many health workers and patients" (p. 488). Such a development also likely would lead to a failure of the concept of m
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Approximate Word count = 5475
Approximate Pages = 22 (250 words per page)