Private Management In Healthcare: A Case Study

Decent Essays
The role of private management in Medicare has grown rapidly in recent years. The health insurance advocacy center has broadly stated the dangers of turning these successful community health programs into profit-driven private insurance companies. However, despite efforts by the center and other advocacy groups, privatization continues.
Many regions - including Illinois, Florida and south Carolina - recently concluded all or most of their Medicare services. The only cost control and care coordination for the managed care of the head is sold in the search for quick health savings. For decades, North Carolina has been using its own efficient, innovative management fee scheme to privatize the trend.
The results of managed care, the predictability and accountability of the state's Medicare effect the budget. However, North Carolina's current Medicare program has exceeded
…show more content…
It has been one of the most cost-effective medical projects in the country. According to the external evaluation of German company, this community saves the north Carolina $1.5 billion from 2007 to 2010, with the lowest increase in medical expenditure. In the top 10% of HEDIS scores (a widely accepted measure of health care quality) compared with diabetes, asthma and heart disease, business management. It has received extensive support from suppliers and community members and was recently awarded the U.S. government innovation award.
More than a million people rely on the community care with needed high-quality and user-friendly services. These include some of North Carolina's poor and medically poor citizens, including disabled people, who need long-term services and support, children and pregnant women. Adopting managed care may undermine long-standing relationships between patients and doctors, all in the name of rapid

Related Documents

  • Improved Essays

    When reviewing the Middleboro Physician Care Services case we learn that it is a for-profit corporation that was founded in 2008 and offers non-emergent care services within two locations. One of them at the Alpha center outside of the city limits of Middleboro and the other is at the Beta center in Jasper. Both of these locations offer ambulatory medical care services that are provided on a walk in basis. These centers do not offer any emergency services, and if a patient were to arrive that needed emergency services and ambulance will be called to transport the patient to the nearest emergency department. Physician Care Services specializes in providing services to the public that are convenient.…

    • 743 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    In private practices, the primary care provider has the final decision on strategy, financial decisions, implementation of new process and overall control of how their practices run. Speaking with a Quality Manager from a local health center, Clinica Sierra Vista, I was informed that Community Health Centers are controlled by a management team and a board of directors, there may be a few physicians such as the Chief Medical Officer on the team, but aside from that there is a lack of representation from the care providers which up until recently, never been addressed. It has always been the culture of this organization to allow the management team to control and implement and providers to serve. What providers are realizing is that management teams are out of touch with the day-to-day operations of the health centers.…

    • 366 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    Medicare/Medicaid cuts continue with new costly and restrictive regulations. State and federal agencies are using new tools to redefine and recoup resources. Some days having a vision for the months ahead, putting the pieces together to bring about that vision and having a hand on the immediate issues/challenges seem an insurmountable task. Three years ago the State of Kansas decided they were going to save money by hiring “three middle men” to administer Medicaid funds. KanCare offers 3 privatized managed care plans for Medicaid recipients through a clearing house.…

    • 2125 Words
    • 9 Pages
    Improved Essays
  • Improved Essays

    Along with a detailed history of insurance and political background on how has the health care system changed over the course of a few years, the book presents case studies that shows the financial strain and medical hardships caused by the declining health care system and why it is in a desperate need to reform. Some Americans cannot afford the medicine they need or cannot afford to pay the doctors for any medical help. “Hospitals try to keep out the uninsured because treating those patients will just divert hospital resources away from paying customers” (219). Some companies cannot provide insurance as an incentive with employment like previously either.…

    • 1007 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    Health Policy Case Study

    • 754 Words
    • 4 Pages

    The end of the “separate-but-equal” provision of the Hill Burton Act, the Civil Rights Act of 1964, and federally funded Medicare and Medicaid have changed the way hospitals operate forever. Even privately owned hospitals could no longer continue the segregation and discrimination of people. They simply couldn’t afford loosing Medicare and Medicaid reimbursements, as well as the Blue Cross and Blue Shield plans that would no longer pay for patients unless the hospitals agree to comply.…

    • 754 Words
    • 4 Pages
    Improved Essays
  • Superior Essays

    The idea that the authors have to educate the general public is exceptional. The authors only want to inform others on how medicare can be sustained and what people can do to ensure it is. Issues like medicare and politics can be horrifying for someone to attempt to interpret but Duckett and Peetoom make it simpler and help people understand the aspects of medicare as well as how to make arguments about it. The book allows individuals to form ideas around aspects of medicare that require change and how they can get…

    • 1252 Words
    • 6 Pages
    Superior Essays
  • Decent Essays

    Analyze and comment on economic analyses of health administrative innovations that are germane to the provision of health services. How have these innovations become more important in health care delivery within the context of the Affordable Care Act? Throughout the health care system, it has used the expansion of healthcare insurance for accessing several strategies that are used to promote how the services are delivered which is through models, strategies, and payment structure build on the improvement of health care quality. By using the Affordable Care Act (ACA), it has given the Americans a reason to improve on chosen approaches that would eventually overcome the populations based on the reduction of healthcare cost. Develop a list of similarities and differences between cost benefit and cost effectiveness analysis as they pertain to specific health care service demands.…

    • 293 Words
    • 2 Pages
    Decent Essays
  • Improved Essays

    The Affordable Care Act legislation has been the catalyst for changing how health care is delivered in the United States. A plausible next step is to evaluate how health care is being paid and by whom. The government and larger private insurers are very powerful and have a palpable influence on health care options. Moving to a government operated one payer healthcare system is intriguing and has been accomplished in Canada and other countries.…

    • 316 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    With a cost of about $269 billion annually, the Medicare program is now the second most expensive federal domestic program. It is very important for the Medicare program to begin the process of finding ways cut costs, while still sustaining the program and making it affordable to qualified individuals who are likely on a fixed income. One suggestion that will be explored in this paper is the idea of switching the entire Medicare program from the traditional insurance model to the managed care model which is currently only available with Medicare Part C. Firstly, one will need to thoroughly review Medicare C Medicare Advantage plans; this analysis will review what benefits have been realized by Federal government, providers, and ultimately patients since implementation. Seeing that Medicare Part C is currently using the managed care insurance model, it is time to take a closer look at its structure, along with its advantages and disadvantages. Expanding on the preceding statement will allow one to have the appropriate information to make an informed…

    • 992 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    Managed Care Roles

    • 419 Words
    • 2 Pages

    Describe the roles, functions, and liabilities of the board in a managed care organization. The roles of the managed care organizations are used to reduce the cost of health care services through several forms of methods such as incentives that are useful through patient doctor relationships to develop a better form of care for the patients. “Gale Cengage Learning (2013) reports Managed care” refers to that type of health care system under which medical care and treatment is managed by the entity paying the bills, and not the medical care or treatment provider (physician, hospital, etc.). It is a system dominated by acronyms that identify different services or components, such as HMOs, PPOs, and EPOs.…

    • 419 Words
    • 2 Pages
    Improved Essays
  • Great Essays

    The health care system in aurora is important because many people depend of those services and it may affect those who do not have access. Residents who have access to health care are those with health insurance, Medicare, and also the affordable Care Act that benefit many. According to UC health benefits report, it states “UC health incurred nearly $185 million in uncompensated care cost in 2015 providing services to these patients and many of these new patients were newly insured through Medicaid which covered a portion of their care as a result of the increased availability of coverage through the affordable act.” This report examines the health system of UC health and how it has it has benefited many by offering new services to those who may not have access to paying health care…

    • 1524 Words
    • 7 Pages
    Great Essays
  • Improved Essays

    Managed Care Failure

    • 694 Words
    • 3 Pages

    CMS (2015) informs us that in 1990's managed care plans managed reducing costs by negotiating discounts from providers and used lower cost settings (i.e., hospital versus ambulatory surgery center). As consumers required less restrictive care their utilization increased and such health expenditures increased. This is not because the managed care organizations (MCO's) have failed or they do not contain costs, it is a function of consumer demand. MCO's work diligently to control costs by ensuring the care is delivered in the safest cost effective setting, managing staff patient ratios, leveraging size to obtain the lowest possible price and standardizing the supply chain. MCO's can effectively manage costs, especially when compared…

    • 694 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    As the population ages in the U.S., there is need for medical care among our elderly citizens. Most elderly citizens over the age of 65 have Medicare for their insurance coverage. Citizens can also be approved for Medicare benefits should they be disabled or have end-stage renal disease. So, the question becomes, how is Medicare making an impact on our healthcare ecosystem of today?…

    • 1093 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    These mergers and acquisitions have reduced overall costs for business processes and have spread out some financial risks and have increased their market share. This has allowed better negotiating influence with insurers, other medical centers, physicians, and the government. The horizontal and vertical consolidation of healthcare providers has demonstrated lower business costs but increased costs to consumers and insurers that have revealed a disturbing nationwide…

    • 1084 Words
    • 5 Pages
    Improved Essays
  • Improved Essays

    Plan members must select a primary care practitioner which could be a physician, physician assistant or a nurse practitioner. The primary care is responsible for coordinating health delivery for plan members. Receiving care by a specialist physician will require a referral from the primary care provider (PCP.) This cost containment strategy is intended to avoid service being duplicated by the PCP and the specialist. (www.amjc.com)…

    • 1227 Words
    • 5 Pages
    Improved Essays