who wins witherisa
The system of managed care began in the United States in the early 1900s, in an effort "to provide coordinated health care in a cost-effective way"(Amer. Assoc. of Retired Persons). Until recently," managed care has emerged from the shadows to become the dominant form of health insurance and delivery," succeeding the older fee-for-service program (Zelman and Berenson 2). Today, about 160 million Americans are enrolled in some kind of managed care plan. Managed care "has made health care more affordable andmore accessible for Americans. But sometimes costcutting can lead to lower standards" (Clinton 1).Because managed care plans provide medical care totheir members at a fixed rate, there is a substantiallimit to the medical care each member can receive.Under this system of prepayment, managed careorganizations (MCOs) can profit off every dollar ofrevenue that is not directly spent on patient care.This produces the problem of incentives, ortemptations for MCOs not to provide sufficient medicalcare to their members, all too often resulting intragedy (Fox, et al. 56). This problem explicitly
This loophole requires that "federal lawoverride state laws relating to employee pension andbenefits plans. In sum thus far, Congress has inadvertently placedthe health of working Americans in the hands of theiremployers, which in turn is overseen by the physiciansof the managed care plan. The failure of the intendedrole of ERISA, to protect employees, predominantlyadds to the inefficiency of the managed care system. Despite her doctor's request, UnitedHealthcare insistently denied the hospitalization, butappointed an in-home nurse to attend Mrs. Corcoran wasdeemed to have a high-risk pregnancy because of herhistory with pregnancy-related problems. Benoit's health insurer,Aetna, refused to provide the emergency services heneeded. "Managed Care: What Consumers Need to Know. Although both the taxcode and ERISA were concocted to help and protectemployees, they play an indirect role in shaping theinefficiencies that envelop the employer-based systemof health care. The expressed concern that MCOpolicies and regulations have in interfering with thedoctor-patient relationship is keenly expressed by Dr. Some managed care organizations and insurancecompanies retaliate against doctors who send theirpatients to specialists too many times, or too soon,or order expensive tests that the doctor feel isnecessary but the MCO does not.
Common topics in this essay:
Patient Advocacy,
Zelman Berenson,
Revenue Code,
Franklin Indiana,
Bill Rights,
Psych Assoc,
United Healthcare,
Rights MCOs,
Security Act,
Arg Liability,
managed care,
health care,
health insurance,
april 1999,
21 april 1999,
21 april,
managed care organizations,
care organizations,
bill rights,
patients' bill,
health plans,
patients' bill rights,
care reform,
income security act,
employment retirement income,
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Acceptance Essays
