Week 1 - Assignment: Assess the History of Managed Care

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Week 1 - Assignment: Assess the History of Managed Care

Managed health care has a lengthy history characterized by success and in some cases customer dissatisfaction. Nonetheless millions of people rely on some form of managed health care. Historically, this country’s health care industry was made up of a large number of independent health care providers who owned their own practices. These were either solo practices or practices jointly owned by physicians who practiced together in a clinic setting. Furthermore, almost all communities of any size had their own hospital, most of which were independent from one another. These facilities were frequently run as nonprofit institutions. The provision of basic medical-surgical services has always involved a broad continuum of care. To be effective, a managed care organization must align the financial incentives and goals of all the parties: the health plan with its benefits and the providers who deliver care.

For you to fully understand this important cornerstone concept, research and then write an analytical paper on the history of managed care.

In your paper, address the following:

  1. Validate the meaning of managed care as it has been used in health care using relevant scenarios to support your reasoning.
  2. Examine the history of managed health care systems taking your reader chronologically through its evolution.
  3. Assess the impact of managed care on the public’s health.
  4. Ascertain your role as a healthcare leader in the management of an effective healthcare system.

Support your paper with a minimum of five scholarly sources. In addition to these specified resources, other appropriate scholarly resources, including older articles, may be included.

Length: 5-7 pages, not including title and reference pages within the last five years; APA style

Your paper should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards.

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Nginah
School: Rice University

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Running head: ASSESS THE HISTORY OF MANAGED CARE

Week 1 - Assignment: Assess the History of Managed Care
Name
Institutional Affiliation

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ASSESS THE HISTORY OF MANAGED CARE

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Week 1 - Assignment: Assess the History of Managed Care

Validate the Meaning of Managed Care as it has been Used in Health Care Using
Relevant Scenarios to Support your Reasoning.

The healthcare system in the United States is unique compared to other industrialized
wealthy nations. This is particularly with regards to the country’s reliance on the private sector
for aspects of healthcare like financing, purchasing and delivery. All forms of government have
public expenditure of as much as 45%, particularly for purchase of health services for specific
demographics (Hayes, Barlow, & Nelson-Gray, 2009). The large portion of U.S. residents
receive their healthcare insurance through their employers and access healthcare through the
private sector. There are considerable tax subsidies for employers for private insurance and
employees share in these benefits. There are, however, a large number of Americans who lack
the private and public health insurance and have limited access to medical resources offered in
the private sector (Hayes, Barlow, & Nelson-Gray, 2009). They, instead, receive care through
establishments operated publicly or make out of pocket payments to private providers. The U.S.
devotes the largest percentage of its GDP to healthcare in comparison to other industrialized
nations.

Under conventional insurance, the financing aspect of healthcare follows the patient.
Patients are given autonomy to select and visit healthcare providers. Providers then send the bill
to the private insurer or public payer and their services are reimbursed based on a fee-for-service
structure or per case (Hayes, Barlow, & Nelson-Gray, 2009). Indemnity plans limit demand
using financial barriers like deductibles and coinsurance on patients rather than using constrains

ASSESS THE HISTORY OF MANAGED CARE

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on the healthcare provider. Many systems require the patient to reimburse the provider and seek
payment from providers.

Until the recent past, conventional insurance plans did not cover routine care. For
instance, Blue Cross had separate plans for hospitalizations and doctor visits. Most plans w...

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