Managed Care Techniques in Medicine

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Managed care refers to various techniques, which are intended to; improve the quality of health care with a minimum cost. Health maintenance organizations (HMOs) refer to managed care services in the United States that are intended to cut down unnecessary health care costs via a variety of mechanisms. The introduction of HMOs dramatically changed the health care industry in the U.S through price competition amongst health care providers.

The impact of HMOs on the health care market has been diversely studied with inconsistency in findings. These differences can be attributed to differences in geographical regions or time periods of study. As the hospitals adopted the new system of price competition, the effects of managed care have advanced with time and may vary across regions. Differences in methods of study also have a significant contribution to these differences. Only the studies that have used a fixed time interval mortality rate as the measure of quality focus on Medicare patients. The use of in-hospital mortality as a quality measure may lead to bias in findings.

Managed-care plans contracted with hospitals selectively to form networks of hospitals to provide health care to their insured members. This selectivity in contracting introduced price competition, in the health market affecting lower rates of hospitals cost growth and lower rates of use of costly services and technologies, (Zwanziger and Melnick, 1988). Evidence shows that HMOs have led to quality competition in mature managed care markets.

Rogowski, Jain and Escarce’s article reflects on the effect of hospital competition and HMO penetration on hospital-quality care for six medical conditions. These conditions included acute myocardial infarction, stroke, hip fracture, congestive heart failure, gastrointestinal hemorrhage and diabetes mellitus. These conditions’ selection was due to their low variation, meaning that the criterion for admitting patients is narrowly defined. The need to assess these conditions is because HMO penetration and hospital competition may have an influence to hospitalization decisions.

The study states that hospitals with a high-competition degree had lower mortality rates within thirty days of admission to the hospital. Analysis using a Herfindahl index to measure hospital competition showed that higher competition lowered mortality rate of hip fracture, stroke, gastrointestinal hemorrhage, diabetes and congestive heart failure. Implications show that patients hospitalized in public hospitals were less ill than those hospitalized in private hospitals.

The author concludes ‘that hospitals compete on “true” quality of care’, implying that reduced hospital costs and use of resources resulting from price competition due to managed care plans and HMOs in California led to improved hospital care.

The study showed that the hospitals in California that faced high competition provided a better quality care for various medical conditions. The studies’ findings also indicate that higher HMO penetration led to high-quality care, and the salutary effects of hospital competition on quality are more robust in higher penetration markets.

Principles of biomedical ethics require a conversation on the desires and needs of the patient, and the members of society. In case of justice, due process should be executed so as to come up with acceptable, just limits on health care provision.

The principle of autonomy advancement in managed care denotes the Principle of Respect, which holds that individuals have the right of choice in developing their own life plan. This principle of autonomy in a health care setting refers to the principle of informed consent, whereby treatment preferences should be discussed with the patient.

The principle of justice requires that goods and services distribution is fair. Health practitioners and society should treat equal cases equally; in that two patients who have a similar medical condition should be subjected to the same method of treatment. Basis of urgency, benefit to the patient, duration of benefit and change in quality life determines medical needs.

Conclusion

As per the article, I agree with the authors views that managed care has impacted health care provision positively. He provides a detailed literature review and results to support his deductions. The selection criterion of medical conditions eradicated all possible sources of biases in the course of study. The study sample selection criteria are refined in four different ways, first with exclusion of certain clinical variants so as to create clinically homogeneous samples.

Secondly, considerations for the first admissions, this meant that no other admission had occurred for the last 90days for that condition. The next criterion of choosing samples was the exclusion of admissions of the first quarter of 1994 and December 1999, this provided a 30-day mortality assessment without censoring. Finally, exclusion of admissions in hospitals that had less than 25 admissions for that condition in the course of the study period.

This made that the results got from the study were bias-free. The hospital competition findings exploration was adversely done using alternate measures and additional sensitivity analyses. The influence of unobserved severity of illness was also explored in the study.

With the elaborate study done by Rogowski, Jain and Escarce, I support the view of the positive impact by the HMOs in quality health care provision in California.

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Managed Care Techniques in Medicine

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