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The main idea of the required reading, Chapter 9 in Essentials of the U.S. Health Care System is to discuss the essence, methods, and effects of managed care and integrated systems in the national healthcare sector. The authors admit that today many insured Americans address available private and government to cooperate with managed care organizations (MCOs) and maintain care costs (Shi & Singh, 2019). Among a variety of strong ideas presented in the chapter, I would like to address such points as managed care characteristics and the impact of the chosen system on care quality. One of the most successful elements applied by MCOs is the possibility to manage financing, insurance, delivery, and payment independently (Shi & Singh, 2019). Financial premiums are usually discussed by employers and MCOs that take responsibility for risk assumptions. Contacts with physicians, hospitals, and other care stakeholders allow MCOs to choose their own physicians and control costs and most payment agreements. Finally, several payment methods (capitalization and discounted fees) create additional opportunities to succeed in managed care.
Another interesting point for analysis is the evaluation of the MCO’s impact on the quality of care. It is usually expected that financial and organizational changes bring positive outcomes in care quality. However, Shi and Singh (2019) admit that certain controversies regarding the relationships between MCOs and care quality exist. On the one hand, financial shifts do not promote great behavioral improvements because physicians face multiple responsibilities for their patients. On the other hand, most managed care plans are associated with cost-effectiveness but not with minorities (racial diversity and socioeconomic status). Therefore, attention should be paid to Medicaid and Medicare, which might reduce expenses and improve the quality of care. Chapter 9 proves that managed care has its pros and cons, and it is wrong to judge the system from a particular perspective but focus on each characteristic and its further contribution to the healthcare sector.
Reference
Shi, L., & Singh, D. (2019). Essentials of the U.S. health care system (5th ed.). Jones & Bartlett Learning.
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