Assignment

In what way does managed care manage cost? Does it do so without diminishing the quality of care? If so, how does it accomplish this?

Introduction

Managed healthcare manages the cost of health without compromising quality care. Healthcare stakeholders particularly health insurance providers have sought means of managing escalating costs of healthcare. Traditionally healthcare relied on a fee-for-service model whereby doctors and hospitals charged set treatment fee. The model characterized by an exaggeration of payment or conducting of unnecessary medical procedures on a patient upon which the private insurance company or individual patient paid the treatment cost(Koltov&Damle, 2014). Furthermore, the cost of payment shared amongst patient and employer. Again the system of payment did not cater to severe diseases, andin case they do the health insurance company increases premiums for employer and individual.

Shifting from fee-for-service to value-based program has significantly managed the cost and quality of healthcare service delivered. The value-based system ensures that only the best performers incentivized. The system uses financial incentives to reward healthcare service providers for better performance that is patient-centered and not one that’s focused on profit alone. Again the VBP reimburses all healthcare providers according to the level and quality of services offered. The model ensures that health care providers concentrate on quality service delivery and not quantity (Doran et al. 2014). Therefore the model comprehensively manages the cost of healthcare while improving quality. The value-based model ensures that health providers comply with established best practice and that customer are satisfied.

Managed health care services guarantee well-coordinated health services and that practitioners comply with professional ethics and code of conduct. In conclusion managed care has more other benefits like reduced medical error; traditionally doctors have been involved in several negligence cases whereby they perform some unnecessary procedures to increase the cost of treatment. The managed care holds all practitioners responsible for any system done.

References

Doran, T., Kontopantelis, E., Reeves, D., Sutton, M., & Ryan, A. (2014). Setting performance targets in pay for performance programmes: what can we learn from QOF?.BMJ, 348(mar04 7), g1595-g1595.doi: 10.1136/bmj.g1595

Koltov, M., &Damle, N. (2014). Health Policy Basics: Physician Quality Reporting System. Annals Of Internal Medicine, 161(5), 365. doi: 10.7326/m14-0786

Report to Congress: Plant to Implement a Medicare Hospital Value-Based Purchasing Program (2007). U.S. Department of Health and Human Services

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