Explain How Managed Care Plans Contribute To Public Health Practice

A comparable example of government run health care is the Veterans Health Administration (VHA). The VHA is generally considered to be poorly managed, with many veterans having difficulties making appointments and long wait times. Opposition to a single-payer system suggest that the issues with the VHA are reason to believe that the same issues will be present with universal government run health care. Also, according to NCPA.org, “Most public insurance in this country is actually administered by private insurance companies” and “most people with public insurance are in private sector health plans” (Goodman). This means that many positive examples of organization and administration we’ve seen so far with our public health care options, such as Medicare and Medicaid, have actually been outsourced to be managed by private

One of the most sensitive subject in the United States today that is most discussed and debated revolves around the issue of our healthcare system. Unlike the many developed countries, the healthcare system in America is not public, meaning that our country cannot provide free or affordable healthcare services to its citizens. So everyone has to pay out of pocket for their treatments or for their visits to the doctors office. Healthcare is one of the most expensive thing in the U.S, our country spends so much money on healthcare than any other country around the world. Over the last decades, no other aspect of the healthcare system has lost its shine as much as aggressive health care.

You are a new physician setting up your practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several healthy plans to speak with you about the benefits of choosing their plans.

The affordable care act presented the United States with the most extensive overhaul since the passage of Medicare and Medicaid in the 1960’s. The act was a response to staggering statistics on the price of healthcare and the resulting uninsured rate within the United States. The affordable care act uses Individual Mandate and Health Insurance Exchanges to combat major factors causing high insurance cost and low insured rates.

Health care should not be considered a political argument in America; it is a matter of basic human rights. Something that many people seem to forget is that the US is the only industrialized western nation that lacks a universal health care system. The National Health Care Disparities Report, as well as author and health care worker Nicholas Conley and Physicians for a National Health Program (PNHP), strongly suggest that the US needs a universal health care system. The most secure solution for many problems in America, such as wasted spending on a flawed non-universal health care system and 46.8 million Americans being uninsured, is to organize a national health care program in the US that covers all citizens for medical necessities.

The Effects of Regulations on Managed Care and IDS Managed Care is a health care delivery system organized to manage cost. The legal and business imperatives of managed care pervade our national healthcare system, the regulation of managed care depends on who contributes to the plan and who bears the risk for paying for the insured services. More than 170 million Americans receive health care coverage or benefits through some type of "managed care" setting.1 By 2007 about 20 percent of these services are directly provided by a health maintenance organization (HMO), while the majority are served through other managed arrangements, 60 percent in Preferred Provider Organizations (PPO) and 13 percent in Point of Service (POS) plans. Beginning

Under direct contracting, providers must go beyond their traditional roles as suppliers of care to owners of integrated financing and delivery systems. This transition can be difficult for employers to compile and manage actuarial and legal mandates. A physician group can be presented as a threat to health plans, as it does business by obtaining an insurance license. This is because the subcontractor is a competitor. Providers must become active managed care partners with employers, instead of being reactive adversaries of managed care organizations on a contractual basis.

For both the uninsured group and those who are eligible for government assistance because of their low economic position, access to health is limited by the number of private providers willing to treat them. In many cases private providers are linked to particular private health insurance companies and won 't accept patients outside their network. These people must then rely on the overburdened public health system for care, and as such usually only seek treatment in emergencies. The public health system, while filled with competent staff, is nevertheless restricted by its funding and can therefore not always provide all these patients with the best quality of care. The inequality in health care access is a continuing issue in America and as such it is important for future consumers and workers on the Foothill College campus to have a thorough understanding of the issue so they can move to improve the problem in the

Managed Care plans are also known as prepaid health care plans. Managed healthcare plans strive to deliver high-quality healthcare, while controlling cost. Services and fees are negotiated with healthcare providers and facilities to provide access to otherwise expensive healthcare services to patients. Services under listed within the Managed Care plan monitored continuously to ensure that all services are provided in the most cost effective manner. An HMO or Health Maintenance Organization is an example of a Managed Care Plan. In an HMO, a patient pays a monthly premium and only has access to doctors, hospitals, and other healthcare providers that are within the HMO network. To participate in an HMO, the individual must pay a monthly premium,

“Healthcare Reform 101,” written by Rick Panning (2014), is a wonderful article that describes, in an easy-to-understand language, the Patient Protection and Affordable Care Act, signed into law March 23, 2010. The main goal of the Patient Protection and Affordable Care Act was to provide affordable, quality healthcare to Americans while simultaneously reducing some of the country’s economic problems. Two areas will be covered throughout this paper. The first section will include a summary of the major points and highlights of Panning’s (2014) article, including an introduction to the ACA, goals of the signed legislation, provided coverage, and downfalls of the current healthcare system. The second part will be comprised of a professional

Some variability differs with the capability of providing out-of-network health providers and the services in which can be provided. By having a broad range of choices that can be provided, will cause a higher the cost for the individual that is paying. Most Medicare patients have received the managed care plans due to promises of a lower copayment amount and often medication benefits. Medicare post-acute spending has grown rapidly with the number of users between 1999 and 2007. The growth in Medicare short-term post-acute service use, in part, reflects short hospital stays and a growing demand for rehabilitation services.

Should the government play a key role in aiding the uninsured, or should market forces reign supreme?

A patient is going to have a different idea of how a health care should be managed. This in contrast to the way a physician may think the administration should be managed. Furthermore, each different stakeholder involved would have their own ideal reasons to why the health care administration

(par. 2), “one local hospital charged an uninsured patient $29,000 for an appendectomy that would have cost an insured patient $6,783.” (par. 5), and “the uninsured account for only 2 percent of its patients, but 35 percent of its profits” (par. 5). The details and numbers build an appeal to logos and influence the reader that health care is a

In 2010, President Barrack Obama signed the health care reform into law, the Affordable Care Act (ACA). Community-Based Collaborative Care Network Program is a part of the ACA which emphasizes primary care, funds community health initiatives, and promotes quality care for more coverage for those uninsured in the U.S. and is more cost-effective to generate billions of dollars in savings for the United States budget. Policy makers and public issues and concerns are growing on cost of health care, affordability and accessibility of health care, health care quality, development of sustainable solutions to health care problems, and promoting personal and community responsibility for health. Future nurses must be prepared to address today’s health