The Quality of Care Under a Managed-Care Program, Essay Example

Introduction

Government regulated health care in United States of America is operated under the managed care system. The intention of adapting government regulated health care within the boundaries of managed care is to control the cost pateints/client pay as well as improving quality of care. The question here is how cost can be controlled and quality of care improved at the same time? From my investigation government regulated healthcare reduces the cost of care government delivers to the population, but quality is not guaranteed.

Many controversies surface regarding managed care in America and another form of government regulated health care within the country. America has a long history of disparities in health care quality among its citizens. With health insurance eligibility, Medicare and Medicaid criteria for quality healthcare coverage government regulated care has further comprised the type of healthcare citizens are entitled to under these various programs designed ultimately to give less at a higher cost.

Development

For example, under managed care a client/ patient does not have a variety of choices regarding quality of care even though he/she is told that they do. The facts are that care is delivered within a network and through that network all services must be accepted. If pateints/ clients do not want to stay within that specified network they have to pay more to see the specialist or desired physician. Clearly, cost reduction in government regulated care under United States of America managed care system pertains to government controlling the huge healthcare cost bill it already has to fund. Presently, there is a huge deficit in the health care budget, which must be regulated (Kongstvedt, 2001).

Further, analysts have evaluated government regulated health care quality under managed care as it pertains to mental health in America. The study assessed rates correlating   mental health care performance measures in the Health Employer Data and Information Set (HEDIS) ( PATH, 2014).  It was discovered that there needed to be more efficiency in medical care, generally. More transparency in reporting quality of care rendered to recipients is currently required. Precisely, allocation of   more fiscal resources towards improving quality of mental health care among HMO’s in United States of America was mandatory. It must be noted that this study represents just one aspect of health care under managed care which compromised quality of health care citizens of America are receiving ( PATH, 2014).

Herein lies the evidence that government regulated healthcare reduces the cost of care government delivers to the population, but quality is not guaranteed. Other evaluations conducted by Robert L. Kane; Patricia Homyak and Boris Barshefsky (2005) indicated that the dual eligible population to be serviced under managed care protocols poses a challenge to providers. Significantly, Medicare and Medicare recipients represent the highest group of clients eligible for healthcare benefits. Providers found that there healthcare needs are not appropriately addressed under managed care system which is government regulated (Kane, Homyak & Barshefsky, 2005).

Conclusion

Many concerns surface over time regarding government regulated care as promised under managed care protocols in America. They surround whether there is any improvement in care quality. In my humble opinion there is no guarantee of quality when cost has to be reduced. The focus is cost reduction and not quality improvement. Common sense tells the tale. If someone wants to reduce cost would it be wise to improve quality? Basic economic principles project that once cost goes down quality goes with it. Therefore, government regulated care under managed care system in America is a myth. Government regulated healthcare reduces the cost of care government delivers to the population, but quality is not guaranteed

References

Kane, R. Homyak, P., & Barshefsky, B. (2005). The Quality of Care under a Managed-Care Program for Dual Eligibles. The Gerontological, 45(4); 496 -504

Kongstvedt, P. (2001). The Managed Health Care Handbook, Fourth Edition, Aspen Publishers, Inc

PATH (2014). Mental Health Care Quality under Managed Care in the United States: A View From the Health Employer Data and Information Set (HEDIS). Retrieved on May. 8^th, 2014 from http://pathprogram.samhsa.gov/(S(swxdpt45d2v4naihnni5ff45))/Resource/Mental-Health-Care-Quality-Under-Managed-Care-in-the-United-States-A-View-From-the-Health-Employer-Data-and-Information-Set-HEDIS-20058.aspx