Term Paper on "Managed Care Health Reimbursement Systems"

Term Paper 4 pages (1362 words) Sources: 1+

[EXCERPT] . . . .

Accountants working as third party agents in the managed care system generally keep track of the number of enrollees (Patients) seen by the physician each months, and the number of claims made or average number of claims per patient (Camperell & Mitchell, 1995).

Generally economists predict that the trend toward utilization of managed care services will grow because at best it is a means to help control health care costs and provide health insurance to a greater number of people over the long-term.

The managed care movement is growing as some state "by leaps and bounds" and has impacted the medical profession as a whole as well as patients in many ways (Barron, 1997). It is important to note that physicians working under the managed care system are no longer to work as independent contractors managing medical care for patients and hospitals (Barron, 1997). Rather now due to the fact in part that physicians income is coming from third party payers such as insurance companies, physicians are operating more under a for profit system where money becomes the primary issue at times rather than the patient.

Commentary Managed Care

Are managed care programs beneficial? There are many people that despise managed care organization and fight against their existence. Many people have a negative view of managed care services. Most patients and consumers fear that managed care organizations promote the use of substandard health care policies. Others generally do not like the idea of not working through an independent physician. People who grew up in an era where they were free to utilize medical services in any manner they choose are generally turned off by the idea of a managed care program.

There are several legal steps being taken however to assuage patient fears regarding malpractice and inadequate care. Laws are being created that protect patients from inadequate care resulting from managed care practices, helping to reduce some of the fear and distrust associated with use of a managed care system (Cauchi, 2001). Generally practitioners are also working to help patients feel as though they are still getting the preferential treatment they deserve and working to make patients feel like people rather than numbers.

Despite any expressed distrust of managed care systems, the number of patients enrolling in managed care programs grew to almost 200 million in recent years (Cauchi, 2001). Managed care programs generally vary from state to state, with regard to access to care, quality and patient resources for complaint should the need arise (Cauchi, 2001).

Some have proposed legislation to better manage "managed" care including consumer "report cards" that allow patients to read reports comparing managed care health companies, doctor profiles which would provide consumers with information about a physicians strengths and weaknesses and consumer assistance offices that would act on behalf of patients denied care under managed care programs (Cauchi, 2001).

Despite the perceived weaknesses of managed care organizations, they do provide access to health care for a large majority of individuals that might not otherwise have the opportunity to access adequate health care coverage. For this reason they are likely to stay around for some time.

It is important in an age of sky rocketing health care prices that consumers are afforded some avenues for health care assistance. More and more managed care programs are stepping up to serve this purpose and assure patients of quality care at a reasonable price. Yes there are some restrictions that managed care places on patients. In the long run however most patients will agree that some health care is better than the alternative, which is no care.

References:

Barron, B.A. "The price of managed care." Commentary, 103(5):49

Camperell, K.J. & Mitchell, R.A. (1995). "Managed health care accounting." Journal of Accountancy, 179(4):68.

Cauchi, R. "Making the best of managed care." State Legislatures, 27(6):22

Dranove, D. (2000). "The economic evaluation of American health care: From Marcus

Wellby to Managed Care." Princeton: Princeton University Press.

Kabalka, L.E. &… READ MORE

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