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Health Care System Evolution Paper: Managed Care

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Health Care System Evolution Paper: Managed Care
HCS/310
March 12, 2012
Shannon Packard

Health Care System Evolution Paper: Managed Care
The evolution of the heath care delivery system in the United States has led to the Managed care initiative. “Managed Care emerged at the early 20th century when the United States lacked private and public health insurance” (Rodwin,p. 653, 2010). Managed Care is defined as “any arrangement in which an organization, such as an HMO, another type of Doctor-Hospital network, or an insurance company, act as an intermediate between the person receiving care and the physician (“managed care,” n.d.). Managed care has influenced the current health care system many times over including spurring the creation of HMOs and PPOs.
Managed care grew significantly partly in response to physicians and other health care providers charging more and more for services provided in a competition to control the medical market (Rodwin, 2010). These physicians had a serious conflict in interest between trying to sell medical services, in an effort to charge more, and doing what was in the best medical interest for the patient. Managed care has brought about significant change in the way the health care delivery system is handled.
Often times, now, a doctor is reimbursed for what is considered, medically necessary, based on a patient’s diagnosis and the normal course of treatment for that diagnosis. They are also reimbursed at a pre-determined rate for specific visit types. This has led to patients needing pre-certification or authorization from their insurance companies for certain tests or procedures. Managed care also lead to the Point of service insurance plans where patients saved money by staying within a specified network of providers. This type of plan is still used today where a patient can save significant amounts of money…...

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