Define, compare and contrast fee-for-service and managed health care plans. What are the similarities and differences? Support your response with one citation and specific examples. Fee for service plans “Fee-for-service plans contain a variety of stipulations designed to control costs and to limit a covered individual’s financial liability” (Martocchio, 2014, p. 147). This agreement is that the consumer pay individually for each aspect of the goods or services receives.
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.
The primary reason why the managed care model was created to provide satisfactory and best healthcare to all the enrollees at reduced and controlled cost and its aims to ensure that the healthcare provide a suitable medical condition of the patient and safeguarding such services are provided by appropriate provider. Its emphasis on keeping enrollees healthy to reduce use of services. The two types of Managed Care is Preferred Provider Organization (PPO) the other one is Point of Service (POS) plans. The difference with the PPO is that this is not a restricted as the HMO plan and allows people to approach providers outside of the network.
Managed Health Care is described as a multitude of various systems and arrangements that are utilized for managing, delivering and evaluating care (Morton, 2014). People enroll in a managed care system as an effective means to receive appropriate medical services within the parameters of their selected plan (Morton, 2014). Managed care, develops services around the patients’ needs in order to reduce duplication and costs all while providing appropriate levels of service in a timely manner (Morton, 2014). Managed care works by, health care professionals and service managers managing care within established constructed restraints all while delivering timely and appropriate health care services. When compared to standard medical insurance managed
Investor-owned, for profit hospitals grew from a physician owned facilities, before the 1965 Medicare and Medicaid legislation to 982 in 2009. (Sultz and Young 2010). The physician-owned specialty hospitals have limits on their services. Such three major categories are, orthopedics, surgery and cardiology. The new specialized hospital delivers greater efficiency, and take pride in the excellent care provided in their targeted services.
The article Advance Care Planing - A Primer, which written by Karishma Taneja, Puneet Sayal since 2015 summer. The major theme in this article which is about pain assessment, the substitute decision making (SDM), the end of life (EOL) care, Ethics of Care and advance care plaining (ACP). Advance care plaining (ACP) which is an individuals make decisions that people who can arrange their own spirit of the time, through the default instructions. It can indicate that he/she does or does not wish to receive medical care, when he/
Studies show that manage care that have a higher level of control on patient care it leads to lower medical cost and hospital inflation on cost(Bundorf, Schulman, Stafford, Gaskin, Jollis & Escare, 2004). Also, manage care controls the fees that are paid to physician and manage medical equipment that is provided to the patients (Bundorf, Schulman, Stafford, Gaskin, Jollis & Escare, 2004). The studies show that it is a spillover for manage care and it affects the no managed care patients (Bundorf, Schulman, Stafford, Gaskin, Jollis & Escare, 2004). Most doctors feel that manage care is a positive step for controlling the cost for healthcare. They also, feel that it have a negative impact on medical care (Deom, Agoritsas, Bovier & Perneger, 2010).
Interesting point about the increased reimbursement rates. One way of looking at the increased reimbursement is the increased preventive care visit to providers and hospitals. Although older individuals who received Medicare, are at that stage in life where as we age the body began to break down requiring frequent visits to healthcare providers and more trips to the hospital. During the 1980sm however,m medical advances and cost-containment measures caused many procedures that once required inpatient hospitalization to be performed on an outpatient basis (Shultz & Young, 2010). Hence, this was the beginning for Medicare and other insurance decreasing hospital stays.
Today is my last working day under the Transitional Care Team. I 've enjoyed being a part of your team for the past 2 years. My position was rewarding serving a group of people who help others in the hospital. I feel that it is time for me to move on to new opportunities.
Healthcare is continuously advancing and a lot of these advances can be attributed to retrospective analysis and building on the analysis towards future practice. This form of analysis allows for the reviewal of many factors such as: (a) patient situations, (b) past practices, and (c) patient outcomes. Reflections of actions that have occurred in the past begin from the moment something has occurred, but it does not end there. When past events are viewed from the perspective of new skills and knowledge, great insight and growth can be harnessed to improve future patient care.