Changing the US Health Care System, Coursework Example

Managed care is a method of financing healthcare that has its roots back in the 1920s, and this type of system is designed to enable providers to manage the costs of care, promote stability in pricing for procedures and services, provide a centralized location for patient records, and maintaining high quality care (Mason et.al, 2013). Managed care has experienced a number of changes over the decades in response to the demand for improved services and expanded provider options; therefore, some of these programs have become more flexible and have fewer restrictions in response to these demands (Mason et.al, 2013). Managed Care Organizations (MCOs) represent one type of program that are held accountable through various state and federal regulations; furthermore, Medicare and Medicaid have also adopted different components of managed care within their own programs (Mason et.al, 2013).

Managed care programs support a greater understanding of the challenges of providing high quality healthcare under a variety of conditions, including those that impact access to care and that minimize barriers to many necessary healthcare services (Andersen & Davidson, 2013). These factors support a more effective understanding of managed care as a means of promoting effective health policy and the creation of new opportunities to achieve sustainable growth within healthcare practice (Andersen & Davidson, 2013). Healthcare under a managed care system has its advantages and disadvantages, whereby care is available from a variety of providers within a given plan in different locations. However, managed care is also limited in that only those providers within the plan are covered by insurance, which may be difficult for some persons to accept when their preferred physician is not in the plan. Managed care plans also have different out of pocket costs, depending on the plan and the amount of coverage that is provided. These factors are components of managed care plans and provide different alternatives for members.

Managed care has contributed to a number of ethical and legal questions in a number of areas. This phenomenon requires a high level of organization and ethical accountability on many levels in order to optimize the care and treatment that patients receive. However, this is not always the case, as many factors contribute to weaknesses within this system that limit progress and the ability to achieve health outcomes that are based on high quality care and treatment. These factors may contribute to a damaged reputation for some managed care organizations, particularly if these problems are ongoing and frequent. Therefore, managed care does not always favor the patient, thereby increasing the risks associated with the provision of care.

For patients who require continuous care due to chronic illness, routine visits to the physician and testing are commonplace; however, these alternatives are not always satisfactory in nature, as the care that is delivered to patients may be limited or wasteful (Mostardt et.al, 2013). It is likely that in some cases, patients receive poor care because the coordination of care is limited and does not provide the desired level of focus that patients require to maintain and preserve their health (Mostardt et.al, 2013). This is a serious ethical concern that compromises the integrity of the managed care system and overall standards of care for all patients (Mostardt et.al, 2013). Furthermore, organizations working in the managed care business do not always demonstrate sound and reasonable judgment with respect to the needs of patients, particularly with elderly patients who are on a fixed income. Under these circumstances, quality of care may be severely limited and does not meet the needs of this patient population. This is ethically unacceptable and inappropriate because it limits how and when patients receive care, which could ultimately contribute to poor quality of life and even death in some cases. As a result, managed care facilities must pay greater attention to populations who require a higher level of services in order to ensure that access to care is optimal and appropriate for these individuals.

Nursing in the public and private health sectors is in a continuous state of change, due in large part to the challenges of managed care organizations and the limitations that are placed on standards and quality of care. Under these conditions, nurses are not always able to provide the desired level of care, due to the limitations of the managed care provider with respect to services covered and costs associated with these services. Therefore, it is important to address these concerns more closely because they interfere with the key principles of nursing ethics the principles of nursing practice. When these circumstances occur, it is likely that patients will ultimately suffer and face critical challenges that limit their quality of life, as well as their perceptions of managed care and nursing practice in this capacity, such as the level of care that is provided in mental health services (Delgado, 2010).

The limitations placed on nursing practice by managed care require further consideration because they impact the level of services that patients receive, based upon covered versus non-covered services. This is a serious complication of managed care because it limits what patients receive, as well as how they are treated by clinicians in this type of environment. Nurses are trained to provide the best possible care and treatment to all patients at all times; however, when these conditions are compromised by insurance provisions, this is an ethically compromising situation that may lead to poor outcomes for patients under some conditions. It is necessary to evaluate these conditions and to recognize the importance of developing nursing practice solutions that are creative and efficient so that patient care quality in the manage care setting is not compromised. Nurses must work tirelessly in this endeavor so that patients are supported by nurses in the expected manner. When managed care organizations inadvertently compromise quality of care, it is possible that nursing practice and patients will suffer over the long term, which poses a threat to the integrity of the organization and its mission.

References

Andersen, R. M., Davidson, P. L., & Baumeister, S. E. (2013). Improving access to care. Changing the US health care system: key issues in health services policy and management, 33.

Delgado, K. J. (2010). Ethical Dilemmas in Managed Mental Health Care.

Mason, D.J., Leavitt, J.K., and Chaffee, M.W. (2013). Policy and Politics in Nursing and Healthcare. Elsevier Health Sciences.

Mostardt, S., Weegen, L., Korff, L., Ivancevic, S., Walendzik, A., & Wasem, J. (2013). Developing Efficient Managed Care programs for the Chronically Ill–Ethic, Economic, Legal and Social Aspects. International Journal of Integrated Care, 13(5).