Evolution and Current Trends of Managed Care
As the landscape of health care in America evolved, early care practices of the 1900’s gravitated toward a prepaid medical group practice, leading to a managed care approach to health care. Evolution continued leading to an expansion of health benefits, and various options of providers and services ultimately leading to a rise in health care cost that could not be overcome. This paper will discuss the forces of change for managed care, current obstacles in place and how those obstacles can impact the future of managed care.
In the years from 1920 to 1940 the US health care landscape functioned off of two models of care, prepaid medical groups and early forms of insurance plans that would become …show more content…
The main premise of managed care in US health care has been to focus on improved health outcomes and care efficiency, ultimately decreasing overall health care cost (Lagoe, Aspling, & Westert, 2005). However as various forms and models of managed care began to take shape, lines became blurred and the main focus of cost control and oversight was lost. At the time of Medicare and Medicaid development in 1960, the vast majority of health care was moving toward a third party payer mix. The resulting system of third party payers brought a complexity of providers of care, receivers of care and those who pay for care resulting in increased fees and utilization. As health care fees increased health care cost skyrocketed resulting in staggering raises that outpaced the Gross Domestic Product (GDP) and in ten years from 1960 to 1970 the GDP rose from 5.2% to 7.4% (Kongstvedt, 2013). In 1973 HMO’s gained speed as the HMO act was passed providing encouragement, as well as, aid to promote development (Kongstvedt, 2013). This brought a division of thought between encouraging competition of health care markets versus the idea of future health care reform. The expanding growth of HMO’s brought even more various forms and models to the managed care arena, making boundaries of what each provider offered even further …show more content…
Values of the organization along with its mission and beliefs are also key to stakeholder and business success. Indicators such as quality access, innovation and prevention are all prime factors for a health care business to be successful (Wicks & Keevil, 2014). With this change in business sense, viewing health care as a basic right where medicine is not bought and sold like previous pay for service models, but rather a mutual understanding where stakeholders involved understand it is not just what is due to them, but also what their responsibilities are to other stakeholders as well (Wicks & Keevil,
As the landscape of health care in America evolved, early care practices of the 1900’s gravitated toward a prepaid medical group practice, leading to a managed care approach to health care. Evolution continued leading to an expansion of health benefits, and various options of providers and services ultimately leading to a rise in health care cost that could not be overcome. This paper will discuss the forces of change for managed care, current obstacles in place and how those obstacles can impact the future of managed care.
In the years from 1920 to 1940 the US health care landscape functioned off of two models of care, prepaid medical groups and early forms of insurance plans that would become …show more content…
The main premise of managed care in US health care has been to focus on improved health outcomes and care efficiency, ultimately decreasing overall health care cost (Lagoe, Aspling, & Westert, 2005). However as various forms and models of managed care began to take shape, lines became blurred and the main focus of cost control and oversight was lost. At the time of Medicare and Medicaid development in 1960, the vast majority of health care was moving toward a third party payer mix. The resulting system of third party payers brought a complexity of providers of care, receivers of care and those who pay for care resulting in increased fees and utilization. As health care fees increased health care cost skyrocketed resulting in staggering raises that outpaced the Gross Domestic Product (GDP) and in ten years from 1960 to 1970 the GDP rose from 5.2% to 7.4% (Kongstvedt, 2013). In 1973 HMO’s gained speed as the HMO act was passed providing encouragement, as well as, aid to promote development (Kongstvedt, 2013). This brought a division of thought between encouraging competition of health care markets versus the idea of future health care reform. The expanding growth of HMO’s brought even more various forms and models to the managed care arena, making boundaries of what each provider offered even further …show more content…
Values of the organization along with its mission and beliefs are also key to stakeholder and business success. Indicators such as quality access, innovation and prevention are all prime factors for a health care business to be successful (Wicks & Keevil, 2014). With this change in business sense, viewing health care as a basic right where medicine is not bought and sold like previous pay for service models, but rather a mutual understanding where stakeholders involved understand it is not just what is due to them, but also what their responsibilities are to other stakeholders as well (Wicks & Keevil,