Managed Care has increasingly become prevalent in the United States. Overtime, it has continued to evoke strong ethical concerns regarding its applicability in our contemporary society. Such instances have been exemplified by the issue of efficacy; provision of a product or service with minimum input in terms of resources. Efficacy, as postulated, conjures more pressure on the medical practitioner to increase his/her productivity with minimized incentives. Moreover, Managed Care has been associated with “capitation” of contracts by Health Maintenance Organizations (HMOs) where medical officers are paid “not to attend” to patients. However, a clear understanding of this practice would be essential if we were to term it as ethical or unethical.
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The history of Managed Care can be traced back to early 19th century, when a number of healthcare structures and systems emerged to provide subsidized health services for impoverished communities. These structures appeared in different communities across the United States with the aim of helping a few selected groups access medical care. This initiative was mainly meant for rural and marginalized communities in mining, lumbering, and railroad areas. Locals were asked to pay a small amount of the fee so that they could conveniently get access to medical care. However, in urbanized societies, charitable institutions settled the fee for marginalized communities. It is believed that Health Maintenance Organizations evolved from these practices and thus later came to be known as Managed Care (Wolff & Schlesinger, 2002).
Nonetheless, with the different faces that Managed Care has adapted over the years, criticism for such practices has been heightened. Inasmuch as many communities have benefitted from this initiative, medical practitioners and professionals have sounded an alarm over the continued adoption of this practice. Health standards have been lowered due to the subsidized medical services. Physicians have been forced to offer their professional services at lowered prices thereby rendering poor services. This is one of the most notable ethical concern that has been associated with Managed Care. Moreover, a number of misconceptions have also been insinuated that try to render Managed Care inappropriate. However, there is need for clarifying some of these ethical concerns by determining whether they have impacted negatively on the society and as to whether its continued practice would compromise societal ethical norms.
In this regard, this paper will define the social understanding of Managed Care, identify more instances where it has been associated with unethical practices, clarify such instances and describe its positive contributions towards the development in the faculty of medicine. Some of the issues to be discussed will include: efficacy in medical practice; “capitation” of contracts; quality in medical care and exploitation of these services. Furthermore, positive attributes such as cost-effectiveness; guarantee of medical attention; provision of preventive services and care coordination will also be evaluated thereby elucidating clear perceptions on Managed Care Plans.
Therefore, the purpose of this paper will be to outline past, present and future trends in Managed Care. Furthermore, it will acknowledge the contribution made by Managed Care towards general health sustainability and clarify some of the social misunderstanding associated with it. It shall also seek to clearly distinguish between negative and positive attributes of Managed Care, thereby reducing fallacious thinking regarding universal and social approval of this practice. Lastly, it will provide a schema for further research on this subject by determining some of the areas that need further research.
Through Literary review, we have observed a number of past trends and issues in Managed Care as well as discovered present and future trends that will continue to affect Managed Care systems. Such trends include the collapse in relationships between a patient and a doctor. This has been attributed to the fact that, through Managed Care, patients are restricted to a particular doctor under a company’s payroll. If a patient opted to visit a doctor that is not necessarily linked with the organization, he/she either accommodates the demands of the extra service or the company contributes just a small percentage (Wolff & Schlesinger, 2002). This affects doctor-patient relationship. Moreover, patients cannot develop lasting bonds with their doctors since the company may decide to terminate the services of a particular physician or seize to be identified with a specific medical group. It is in such a case that Managed Care impacts negative in the medical field.
Secondly, through “capitation”, some forms of Managed Care have created the provision through which doctors can now spend very little time on a particular patient. This trend has been observed in the Preferred Provider Arrangement system where for a physician to compensate for the little incentives he received, he would make sure he sees many patients. For him to see many patients, it would mean that he would spend the minimum time possible on a particular patient. Consequently, this also affects the patient-doctor bonding process, exploration of available treatment options for the patient and does not guarantee exhaustive analysis of the patient’s problem. Furthermore, the doctor may end up making the wrong diagnosis hence put the life of the patient in danger (Bierman, A. S., Haffer, S. C., & Hwang, Y. T., 2001). There have been cases where patients have been diagnosed with the wrong illness and thus ended up succumbing due to wrong prescription or treatment.
Mental care plans have been greatly discriminated by Managed Care plans. Mental problems are far much financially demanding as compared to other illnesses. Therefore, many health management organizations have tried to avoid the inclusion of this package in their Managed Care system. The gravity of this issue prompted the drafting of a number of legislations which were presented to Congress for deliberation. For instance, the watered-down parity law, which was effected in 1998, prohibited companies from defining the maximum financial limit for mentally ill patients. Currently, many insurers are championing against this law by weakening it in a bid to render it inapplicable. In this regard, Managed Care programs seem to have failed in establishing parity in all health related illnesses. This is a huge shortcoming for Managed Care practices as it exhibits aspects of biasness.
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Lastly, one striking trend that will pose a great challenge to Managed Care structures in the future is the issue of Medical practitioners in Medical schools influencing their student’s thinking towards Managed Care. Presently, it has been established that most medical students across the United States are anti-Managed Care. This is attributed to the fact that most lecturers, who are health practitioners outside lecture rooms, are influencing their student’s thinking towards this practice. With this trend, physicians who are in the making will ravage this practice in the future thus hurl impoverished communities back to their medical poverty. Therefore, the imparting of negative ideological mindsets by lecturers and faculty members in medical schools should be stopped before it spills out of control. We need to safeguard the much we have achieved and work towards providing more that we could provide. However, Managed Care’s influence on the issues outlined below has shown its positive contribution towards general health sustenance. Positive conclusions can be drawn hence act as an advocate for the maintenance of this practice.
Throughout history, people have struggled to gain adequate medical assistance and this has been linked to lack of financial stability. Managed Care has created a cost-effective working environment where patients, regardless of demographic, racial or cultural background can get convenient healthcare. Structural cost-effectiveness has been realized with incentive impacted cost and inter-group negotiations being simplified. The task of negotiating the price for medical services has been left for the employer and the physician thereby offloading some of the financial burden from the patient, (Bierman et al., 2001). Moreover, in extreme circumstances, patients are able to get access to professional medical care, with modern equipment, medication and follow-up activities that would guarantee a patient’s full recovery. This is one of the most significant achievements realized through the application of Medical Care.
Quality medical practices can be defined in terms of customer satisfaction and medical outcomes, or both. Studies have indicated that Managed Care has heightened responsiveness in creating value products thereby broadening provider networks. Furthermore, it has enhanced corporative relationships among providers and consumers. Utilization controls have also been loosened as compared to fee-for-service systems. A more notable finding postulated that there was not much, if any, difference in terms of quality of services offered between Managed care and fee-for-service schemes. Moreover, a tremendous increase in quality of medical services has also been observed in marginalized areas where such services were minimal. This growth has reduced health vulnerabilities in such areas thus augmenting the general quality of health in the area. Counter claims have been made imploring whether the quality of healthcare has been lowered or raised. Nevertheless, with a reflection on the customer satisfaction model and medical outcomes, most communities have acknowledged a tremendous positive growth.
Lastly, perhaps the most significant contribution of Managed Care is the ease of access to medical services. Medical practitioners defined access to medical care as the ease of patient entrée to medical providers and procedures. We can all affirm that the initial aim of Managed Care, which was to provide access to medical facilities, especially for impoverished populations, has been achieved. Insured and uninsured company staffs are legible for Managed Care as long as their affiliate company has provisions for Managed Care (Bierman et al., 2001). Initially, most employees opted to have their own health insurance programs which locked out those who could not afford an insurer. However, Managed Care, with some minimum fee, each employee becomes technically “insured”. Therefore, Managed Care has eased the way in which people get access to medical care thus achieved its primary goal.
In conclusion, having critically looked at the trend that is affecting Managed Care today and which may as well pose a great challenge in the future, we are still left with one question that remains unanswered. What criterion could be used by employers and medical practitioners in selecting viable Managed Care systems? Managed Care is prone to exploitation by both employers and physicians. Moreover, while physicians are crying foul, they should have an opportunity of drafting their demands, which are reasonable and considerable, especially for the poor man, hence stop providing poor services on the pretext of underpayment. Therefore, a study should be carried out that would seek to find a neutral way of assigning medical affiliations. Patient’s, employer’s and physician’s interests should be evaluated and generate a possible strategy that would be less controversial in Managed Care. This research, therefore, will also offer recommendations for proper legislation of its implementation.
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