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Health Care Reform Project Essay

One solution to managed care in health care is the keeping the cost of the health care down. According to “Health Care Cost Control: Getting on the Right Track” (2002), “A real solution will, of necessity, involve pain for all players in health care: employers, government, providers, insurers, pharmaceutical and medical technology companies, and consumers.” To regain control over the heath care crisis the purchasers and the consumers need to come together and decide what the best resolution would be best for them. They will also need to determine what it is that they are willing to sacrifice in order to reduce the high rate of the health care cost. If this doesn’t work the only other alternative would be for the government to step in and decide what needs to mandated, nobody wants this to happen.

Another solution to managed care in health care is access to affordable health care. According to “Health Care in Chaos: Will We Ever See Real Managed Care“ ”Lack of insurance coverage causes people not only to avoid preventive care, but to delay seeking illness care until later into the episode of illness.” The underinsured or uninsured will wait until they absolutely have to or need to be seen and end up going to the Emergency room costing themselves and other a lot more money out of pocket. If managed care was more affordable then there would be a lot less people needing insurance along with better health for those individuals. There are an increased number of uninsured people in the United States to roughly around 45.6 million people (Health Care in Chaos: Will We Ever See Real Managed Care).

Quality of care in managed care is another issue that is happening. “Medicare HMO enrollees with chronic conditions showed worse quality of care.”(Miller, 2015). The quality of care with HMO’s can be considered poorly done. Most people feel that HMO’s do not get the same type of care as others such as PPO’s this is “in part because of slow clinical practice change, lack of risk-adjusted capitation rates, and inadequate quality measurement and reporting.” (Miller, 2015).

Solutions to these managed care issues all depends on the individual who is insured and wither or not they want to spend a lot of their own money to get the quality of care they are wanting. Most Americans cannot afford insurance either through their employer or through the Affordable Care Act. This is why so many people do not have insurance and have poor health. They are not able to obtain the care they need which then makes health care rise to cover those who seek medical help through the Emergency rooms. More hospitals have to write the debts off which is costing them to lose more money from the patients who are unable to pay for their services.

Having managed care is a vicious circle, you either cannot afford to have the health care you and your family needs or you have health care but it is not very good and you still have to pay a lot out of your own pockets just to be seen and have mediocre care. According to “Managed Care: Get Used To It” (2010) “The concept embodies many modes of delivering medicine, ranging from the nightmarish bureaucratic encounter to the highly professional clinic.” The worst part of managed care is that providers can decide the service and access because the fee of service treatment is limited to what the providers think is right. “All managed care plans have a built-in incentive to limit costs, because more treatments do not automatically mean more revenue for health providers.” (Managed Care: Get Used To It” (2010).


Health Care Cost Control: Getting on the Right Track. (2002). Retrieved from http://www.managedcaremag.com/archives/0202/0202.edge.html Huntington, J., (Jan. 6, 1997) “Health Care in Chaos: Will We Ever See Real Managed Care?” Online Journal of Issues in Nursing Vol. 2, No. 1, Manuscript 1. Managed Care: Get Used to It. (2010). Retrieved from http://www.nytimes.com/2010/03/14/business/14views.html?_r=0 Miller, R.H. (2015). Does managed care lead to better or worse quality of care? Retrieved from http://content.healthaffairs.org/content/16/5/7.short

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