Health Care Reform Essay

2780 Words 12 Pages
Health Care Reform


Several years ago, health care reform was a hot political topic with President Bill Clinton's proposals to revolutionize medical health insurance. Even though his proposals didn't become law, sweeping changes are occurring within the health care system, particularly in regards to managed care health insurance and the reengineering of the hospital. The goals of these changes are to cut medical costs, make the delivery of health care more efficient, and to promote preventive medicine, health, and primary care. While these changes are positive in many ways, they are also creating concerns among both the health care consumer and provider. These changes must be managed to insure that high quality care
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In the late 1980s, costs skyrocketed, and in 1988, employers' health benefit costs rose a record 18.6 percent (Glazer, 1996). As a result, managed care began to take root, and by 1993, a majority of employees were covered by managed care (Glazer, 1996). With medical costs approaching one trillion dollars, 15 percent of the Gross National Product, cost containment is a major issue (Shortell, Gillies, & Devers, 1995). As of July of this year, 56 million people have joined managed care plans (Bennett Clark, 1996), and another 50 million will have joined by 2000 (Spragins, 1996).


At least 1,000 health insurance plans exist but they fall into certain categories (Whigham-Desir, 1996). The traditional plan has been the indemnity or fee-for-service plan. Patients visit any doctor at any time and pay directly for their treatment. They can be reimbursed later, usually for 80 percent of the cost (Whigham-Desir, 1996). These plans are the least restrictive, but the most expensive.

Four types of managed care plans exist. They are the health maintenance organization (HMO), preferred provider organization (PPO), point-of-service (POS), and independent practice association (IPA). In an HMO, the member is offered a specific list of doctors and hospitals from whom he or she must receive care in order to be covered. He or she must also choose a primary care physician clled the "gatekeeper" through whom all care is

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