Economic Issues In Managed Care

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Economics Issues Paper by Anonymous As an adult, most of us enjoy the opportunity to pick and choose what we want in life, in regards to our food, clothes, healthcare and more. Having the option to choose in healthcare is major. This is why Managed Care has become a gift to Americans all over. In the three types of Managed Care plans, each option tries to cater to the needs of Americans all over. A bad feeling is that of being left out, so with Managed Care, it presents three options to choose from, which include, According to "Managed Care"(2010), “The Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care. Preferred Provider Organizations…show more content…
Managed care organizations scrutinize expensive procedures to be sure they are necessary. At times patient desires and needs come into direct conflict with economic pressures. Studies have shown that about 30% of operations recommended by surgeons are unnecessary, the majority of these procedures would accomplish their purpose, and other methods would achieve similar results without operation. Managed care organization will refuse to pay for an operation if they feel it is unnecessary. Another way managed care organizations control costs is by eliminating expensive doctors from their provider list. Expensive doctors are usually noticed because he/she order many more x-rays, CAT scans and laboratory procedures than normal. By using a computer managed care organization can tell how many of these costly procedures each doctor has ordered and how many patients he/she has treated. Doing away with providers who over-use these facilities saves money two ways, getting them off the list first and by making the remaining providers more aware of the problem. Some managed care organizations operate their own clinics, with staff doctors paid salary instead of fee-for-service. It also allows cost-saving measures like using nurse-practitioners or technicians for some jobs normally done by doctors. Managed care…show more content…
E., & Moore, J. (2007), a large number of studies in many markets over many years have consistently shown that medical care managed and financed through an HMO costs 10 to 20 percent less than under indemnity insurance. Most of the savings are due to two factors; the ability to obtain lower prices by contracting for large volumes of hospital, physician, laboratory, and pharmacy services, and a substantial reduction in the number of hospital days per 1,000 enrollees. The reduction in hospital days is somewhat offset by a greater use of ambulatory physician services and outpatient surgery among HMOs, but because these substitutes are less expensive than inpatient services, overall dollar savings are realized even when the quantity of services used stays the same or increases. Although managed care has been shown to reduce costs, it is probably not the answer to all of America’s health care problems. Some HMOs have made money through risk selection, accepting mostly healthier patients. Other HMOs may find it difficult to maintain quality of care once the easy savings from discounting and substitution have been taken and thus may be tempted to reduce services in precisely those areas where patients, hampered by information asymmetry, depend most on professionals for monitoring

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