Managed Health Care Issues Essay

3241 words - 13 pages

When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
With the high degree of variations in health care, patients can be under or over treated or even treated with the wrong treatment for their illness. These unwarranted care techniques can be categorized into three different situations. The first category of unwarranted care is the use of evidence or lack thereof, based on other medical care. The way to explain this category is that a care plan for a patient is proven effective without any proof as to why. The example given by Kongstvedt (2007) is the use of beta blockers post heart attack. Beta blockers prove to be effective in nearly one hundred percent of patients, but the reasons cannot be fully explained. The medical field just knows beta blockers work because proof of the contrary is rare. The second category is preference (Kongstvedt, 2007). When the term preference is used, what it means in this sense is that there is more than one way to cure the patient. This means that the patient has a choice to make between the specific treatments. The patient’s preference to certain treatments defines how utilization management works. Patients in the same region may prefer a single treatment to another or patients of a specific age demographic may opt out of surgery when a younger crowd may see it as the only option (Kongstvedt, 2007). The third and final category of unwarranted care is supply. The term does not refer to supplies as in the usage of equipment or tools needed to perform a job. The word “supply” is referring to the treatment that is most available is the most often used in regards to a patient’s care. For instance, in a state that the majority of the population is elderly patients, who use Medicare, will have higher per capita spending for Medicare patient’s than the states that do not have a high population of elderly residence using Medicare...

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