Essay on "Heath Care Health Care Plans"

Essay 2 pages (988 words) Sources: 2

[EXCERPT] . . . .

Point-of-Service (POS) Plan

Many HMOs offer an indemnity-type option known as a POS plan. POS plans or Open Access HMOs add an out-of-network benefit to HMOs. Like HMOs, members select a primary care physician who manages all their care and is responsible for referring patients to plan specialists. In a POS plan however, members have the option of going outside the HMO network, although their out-of pocket expenses for care received outside of the network will be more ("The Types of health insurance," 2011).

State-Sponsored Health Insurance

These programs cater to limited-income individuals and families. Eligibility requirements vary from state to state. This option is for low-income families, the unemployed, employees who don't benefit from a group plan and senior citizens. State-sponsored health insurance programs include Medicare and Medicaid and can be very inexpensive or free. Coverage cannot be denied based on pre-existing conditions.

Impact of Managed Care on State-Sponsored Programs

According to Rich and Erb (2005) over 90% of all persons with employer-based health insurance coverage in the United States are enrolled in a managed care plan. Only a decade earlier, fewer than three out of 10 people with health insurance coverage were enrolled in such plans. There has, however, been a strong backlash from consumers and providers against managed care. By 2001, all but four states had some type of comprehensive patients' bill of rights or patient protection act.

During the same time that the regulatory backlash was in full force, the federal government was encouraging, and in some cases even mandating, the use of managed care contracts and practice techniques for key public programs. In addition, federal waivers from regular Medicaid regulations were sought so that states could require that Medicaid clients be served through a managed care organization (MCO). This suggests that state legislatures and Congress, the same legislative bodies that had approved the anti-managed care regulations, believed that managed care was the least expensive, most efficient and, presumably, the safest way to provide health care services to the low-income and elderly individuals served by these governmentally financed programs.

Advocates of managed care have argued that, as a strategy for health care finance and delivery, these arrangements can actually provide care to the most needy more efficiently than was possible with the old fee-for-service system. These trends toward the increased use of managed care contracts and practice techniques in both the employer-based private health care and the publicly financed health care systems, along with anti-managed care legislation and regulations, explicitly reveal the dilemma faced by governments in the United States in trying to balance the goals of reducing costs while maintaining a high quality health care system.

References

Rich, R.F. & Erb, C.T. (2005). The two faces of managed care regulations and policy-making. University of Illinois at Urbana-Champaign. Retrieved July 30, 2011, from http://igpa.uillinois.edu/system/files/WP114.pdf

"The Types of health insurance." (2011). Health insurance guide. Retrieved July 30, 2011, from http://www.healthinsuranceadvice.org/types.html READ MORE

How to Reference "Heath Care Health Care Plans" Essay in a Bibliography

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