Review the Health Maintenance Organization Act of 1973.
The growth of managed care in the United States was spurred by the enactment of the Health Maintenance Organization Act of 1973Links to an external site.. Currently, managed care is the main mode of delivery of healthcare insurance in the U.S. However, adoption and utilization of managed care is not without existence of both proponents and critics, who are sharply divided on managed care’s overall impact on U.S. health care delivery. Choose one of the requirements in the SSA and elaborate on its effectiveness.
Are you a proponent or opponent (critic) of Managed Care? Why?
Reference:
SSA.gov. Health Maintenance Organization Act of 1973. to an external site.
Two posts I need to respond to:
Kenzie Weldon
YesterdayJun 6 at 9:52am
Managed care is the most popular type of healthcare in the United States, composed of different types of plans and requirements. One of the requirements of managed care is quality control. This requirement is very important because without it, people could be receiving less than adequate care. Of course, because of this, timing of care is affected as well. Lots of things can affect quality of care like how many patients a doctor is seeing, or how many patients are trying to get in to see a specific doctor. Because of network restrictions, many offices can get overwhelmed easily if there are not enough doctors for the amount of patients trying to get in. This does not affect quality of care directly, however, it can make it really difficult for patients to want to schedule simple check-ups or vaccinations. Overall, I am a proponent of managed care because it can keep costs at bay, however, there are some issues that I have with it. Mostly, I do not understand why dental, vision, and mental health care are not included as a basic health service. It is very frustrating that 3 important things a majority of the population struggles with are often not covered. I know multiple people who have not been to the dentist since they were a child. I know multiple people who use their disposable contacts more than they should because it is cheaper. I know a ton people who can not afford therapy so they continue to struggle with their mental health every day of their lives. It seems like with one of the requirements of managed care being quality control, legislators might look at how much these services are needed for everyones quality of life and adjust the programs.
Kenzie Weldon
SSA.gov. Health Maintenance Organization Act of 1973.
and
Courtney Wilkerson
MondayJun 5 at 10:22pm
Good Evening Everyone!
After reviewing the Health Maintenance Organization Act of 1963 and also the course readings that talk about Managed Care, I believe that I am a proponent of this type of care. According to Harrington “The purpose of managed care is to provide quality and affordable health care to the plan beneficiaries.” (Harrington & Harrington, 2023). I am a proponent of Managed Care because it works and has worked for a long time. It works by partnering with physicians, hospitals and different practices to provide patients with the healthcare that they need and also benefiting the plan beneficiaries such as the employers. It is the most cost-effective health plan that works best and keeps cost at bay by providing patients with great care and plenty of options to help with any kind of medical need.
-Courtney Wilkerson
Harrington, M. K., & Harrington, M. K. (2023b). Chapter 6. In Health Care Finance and the mechanics of Insurance and Reimbursement (pp. 103–116). essay, Jones & Bartlett Learning.
Expert Solution Preview
Introduction:
The Health Maintenance Organization Act of 1973 was a significant piece of legislation in the United States that played a pivotal role in the growth of managed care as the main mode of healthcare insurance delivery. Managed care has both proponents and critics, who have differing perspectives on its impact on healthcare delivery in the country. This response will focus on one of the requirements in the SSA (Social Security Act) and evaluate its effectiveness. Additionally, an explanation will be provided regarding whether I am a proponent or opponent (critic) of managed care and the reasoning behind this stance.
Answer to the first question:
One of the requirements specified in the SSA was quality control, which is an essential component of managed care. Quality control plays a crucial role in ensuring that patients receive adequate care and that healthcare providers maintain high standards in the delivery of services. By establishing certain measures and guidelines, managed care organizations can monitor and evaluate the quality of care provided to their beneficiaries.
The effectiveness of this requirement can be seen in the improved outcomes and patient satisfaction rates associated with managed care. Through quality control, managed care organizations are able to track and maintain high standards of care, leading to better healthcare outcomes. The monitoring and evaluation processes implemented by managed care organizations provide valuable feedback to healthcare providers, allowing them to identify areas for improvement and implement necessary changes.
Furthermore, quality control measures in managed care help in cost containment. By emphasizing preventive care and efficient utilization of healthcare resources, managed care organizations can reduce unnecessary healthcare spending. This ensures that resources are allocated appropriately, leading to more cost-effective delivery of healthcare services.
In summary, the requirement of quality control in managed care, as mandated by the SSA, has proven to be effective in improving healthcare outcomes, enhancing patient satisfaction, and controlling costs.
Answer to the second question:
As a medical professor, I am a proponent of managed care. Managed care has several advantages that make it a favorable healthcare delivery model. Firstly, managed care focuses on preventive care and early intervention, which can lead to better health outcomes and reduced healthcare costs in the long run. By prioritizing preventive measures, such as regular check-ups and vaccinations, managed care helps individuals maintain good health and detect potential health issues at an early stage.
Secondly, managed care promotes coordination and collaboration among healthcare providers. With a network of physicians, hospitals, and other healthcare facilities, managed care organizations ensure that patients receive appropriate and comprehensive care. This integrated approach reduces fragmentation in healthcare and enhances the overall continuity of care.
Moreover, managed care offers cost-effective solutions for healthcare coverage. By negotiating contracts with healthcare providers, managed care organizations can secure discounted rates for services, medications, and procedures. This makes healthcare more affordable for individuals and employers alike, while also ensuring that providers receive fair compensation for their services.
While managed care does have some limitations and challenges, overall, it has proven to be an effective and efficient model for healthcare delivery. It allows for better coordination, cost containment, and preventive care, all of which contribute to improved patient outcomes and satisfaction.
In conclusion, managed care, with its focus on quality control, preventive care, coordination, and cost-effective measures, has significant benefits for both patients and healthcare providers. As a medical professor, I support the implementation and utilization of managed care as a valuable approach to healthcare delivery.
