Implications of Managed Care

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The provision of appropriate healthcare services for the people in the United States has been a major issue for a very long time. The government and the private sector have put forward concerted efforts to enhance the quality of services offered by this crucial industry (Baicker & Chandra, 2007). The essay describes the contribution made by the National Committee for Quality Assurance (NCQA) and discusses the implications of managed care on the ease of access of healthcare by patients.

It highlights the value of credentialing by an independent organization to managed care organizations as well as the consumers. The essay also discusses the merits and demerits of exposing the performance of managed care organizations to the employers and the general public. The relationship between employer-sponsored health insurance and the federal economy will be discussed.

The National Committee for Quality Assurance (NCQA) has made significant contributions towards the improvement of the quality of health care (Sultz & Young, 2005). The purpose of NCQA is to provide accreditation to managed care plans.

Its seal has developed into a recognized symbol of quality and many organizations who meet the set standards have used it to advertise their performance. The NCQA has played a major role in laying out the required standards and quality of health care. All stakeholders have been involved by NCQA in the formulation of expectations in the health sector (Baicker & Chandra, 2007).

Managed care has emerged as the most resent scheme in the health care industry. However, it is facing challenges as far as access to quality service by clients is concerned.

Managed care manages the cost of the various services which has resulted in the removal of the common fee-for-service incentive to demand additional or alternate tests (Sultz & Young, 2005). The principles of managed care, on the reverse, imply that customers are more likely to receive inefficient diagnosis and treatment. This is because the attempt to lower the costs of health care implies lower quality.

Managed care organizations (MCOs) emphasize doctors’ responsibilities to control patient access to expensive hospitalization and specialty care. This practice, however, is unethical since treatment of patients ought to be separated from financial factors (Baicker & Chandra, 2007).

Many argue that it is aimed at enhancing the quality of services offered but there adequate evidence to support this. Patients have been under-diagnosed and under-treated due to failure to meet the financial obligation. MCOs have forced the physicians to regulate the services they offer by using financial incentives and threats. The health care industry is supposed to be more considerate of its clients rather than being run like a business where the investors have financial interest (Baicker & Chandra, 2007).

The National Committee for Quality Assurance has emerged as a credentialing organ for managed care organizations and hence setting the standards. Accreditation of organizations by independent organs is a necessary process and has significant implications on MCOs and consumers (Sultz & Young, 2005).

The process is valuable since it uses advanced approaches to rate organizations in terms of their effectiveness. All organizations will therefore strive to meet the standards set by NCQA which in turn safeguards the consumers, employers and other stakeholders as far as making appropriate choices is concerned.

Apart from accrediting organizations, NCQA aims to measure the performance and produce ‘report cards’ which can be used for assessment purposes. NCQA uses the Health Plan Employer Data and Information Sets to generate information on numerous performance criteria of MCOs.

Allowing the members of the public (patients) to access this information helps them in making informed choices (Sultz & Young, 2005). Employers also get to know and compare the performance levels of various health plans. The process of rating organizations helps raise the standards of health care in the United States. Despite possible objections by the accredited organizations to the publication of the report cards, few, if any demerits can be identified.

Health insurance has also been one of US government’s top agenda in the recent past (Swartz, 2007). There is a notable relationship between employer-sponsored health insurance and the national economy. Research statistics reveal that the cost of providing health care to Americans has been much higher compared to the gross domestic product (Baicker & Chandra, 2007).

Hence there is a negative relationship between the two variables. Since most Americans are covered under the employer-sponsored health insurance (ESI), most private businesses will be negatively affected by increase in health care cost due to the increasing insurance premiums (Swartz, 2007).

The essay has described the contribution made by the NCQ A and discussed the implications of managed care on the ease of access of healthcare by patients. It has highlighted the value of credentialing by an independent organization to MCOs as well as the consumers.

The essay has also discussed the pros and cons of making public the performance of MCOs to the employers and the general public using The Health Plan Employer Data and Information Sets. The relationship between ESI and the federal economy has also been found to be negative.

References

Baicker, K. & Chandra, A. (2007). The efficiency of physician specialization: evidence from the United States. McGraw-Hill Plc.

Sultz, H. A. & Young, K. M. (2005). Health Care USA understanding its organization and delivery (6^th ed.). Jones & Bartlett Learning

Swartz, K. (2007). Reinsuring health: why more middle-class people are uninsured and what government can do. Russell Sage Foundation

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Implications of Managed Care

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