Wednesday, May 2, 2012

Health Care System Evolution Essay

Health Care System Evolution Essay

In this paper I will investigate in Managed care evolution, and its importance in relation to the overall Health Care reform, as well as present and analyze changes that experienced managed care.

In order to evaluate the influence of Managed Care, it is necessary to follow all stages of its development, starting with its emergence, estimate its consequences, key parameters, understand all advantages and disadvantages not only from the standpoint of the client companies, but also for counselors who are working in Managed Care Organizations.


Managed care as the separate service emerged in the beginning of 1990s and had a great impact upon counseling and psychotherapy practices. The great problem at the very beginning was that there were almost no books for beginners and the new staff lacked professionalism. The main reason for establishing managed care was the need in cutting costs for medical treatment, and managed care succeeded in fulfilling this particular task, although the situation was temporary. Consequences of cost reductions were rough, as managed care organization reduced costs not by means of increasing efficiency of services provided, but by decreasing number of clients and decreasing funding of service providers. Managed care brought a lot of new rules and regulations that seemed like another language to counseling professionals, and although they were knowledgeable in their spheres, they had to start learning again in order be able to co-exit with this new type of health care.

There was a conflict between providing best care services at lower costs, as better range of care services, the higher are the prices.

Prices for medical services at the beginning of the 90s were constantly increasing. There were few reasons for that, which included: increases of inflation rates and increases of the costs for the mental health. Lack of professionals in definite spheres also affected the decrease. Some other reasons included: more services were used by the elder people and aging population, improved medical technologies needed more funding; a lot of money were spent on administrative and supportive staff (Altman, 1999).

At the same time federal government started the process of industrialization of health care system in USA. Creation of centralized and structures managed care was inevitable. Even though managed care organization emerged in the beginning of the twentieth century (Western Clinic in Tacoma, 1910, Farmers’ cooperative Health Plan in Oklahoma, 1929 and Kaiser Foundation Health Plans, 1937), the real necessity in them appeared only during last two decades (Dranove, 2000). There were offered three basic stages of behavioral managed care development. The first stage can be characterized by shifting of traditional health insurers (for example, of Blue Cross) to Health Managed Organizations. Their goal was increasing savings and revenues. So, now they focused more upon gaining profit and not providing qualified medical help. These goals were achieved by means of cutting access to particular services (providing only one program out of several that can be four hours by car away).

The second stage was about focus upon large employers, making them the target market. Behavioral health was strongly encouraged to be separated from other medical services. Means were very different for achieving this- from publicity to personal persuasion. Large companies, in their turn, demanded cost control, discounts, and minimum complaints from the side of patients.

The last stage was characterized with the consolidation of the managed care organizations, with the disappearance of traditional insurers from the market and drastic increase in number of licensed professionals who were willing to work, and subsequent decrease in their income.

The first and the most important challenge of managed care became lack of adequate health care. Results of the conducted research showed that people were not satisfied with the provided services, haven’t received in-time services or had problems regarding paying for services. The limited number of providers’ strategy that was originally used to save costs, resulted in bad treatment services, and showed no improvements. When the company that should have taken care of people’s health, transfers to the mission of gaining more, then there is nothing to say about what kind of service they would provide. And even though such a switch was an obligatory measure stipulated by the lack of state funding, quality should also be pursued in any case. There was the change in the types of services offered. The psychotherapy and psychological testing became less profound and complicates by switching to more brief therapy, crisis intervention, medication and substance abuse treatment. The level of specialists also decreased from doctoral levels to common nurses, psychiatrists and bachelor-level specialists.

Simultaneously with all stated consequences, the amount of paper work increased as well as administrative expenses, as the number of administrative staff was greatly decreased, effectiveness of work in this sphere decreased greatly. Practicing doctors were wasting lot of time for administrative work and performed less of their direct job tasks. Another problem with paper work was for the client companies and providers connected with constantly changing rules, regulations and forms. Training opportunities were also very restricted, because of lack of financial resources. Students, who were willing to practice their skills, not payment for their ob was offered for the reason that they were not licensed yet. So, students had problems in acquiring enough clients during their practice. Training problems finally resulted in decreased ability to ensure training upon long-term basis mental health, and switching to short-term, as well as in additional stress for staff in viewing students as additional burden to their every-day responsibilities.

Managed care companies in general are not willing to change their way to do business. And then the question arises upon whether the basic care that they provide is good or bad. In order to answer it objectively, it is necessary to understand to whom good or bad. For client companies (who take care of its employees), patients (who just want to be health and happy) and government (that has to protect rights of its citizens) - it is bad, for managed care companies, which are looking for cutting expenses and gaining more profit, it is good. And the task is to find the best solution, which would benefit both sides, as health care crisis is the stumbling block of ethical standards and human rights.

In the conclusion, I would like to presentseveral suggestions to improve quality of managed care services delivery, which are primarily connected with establishment of democratic allocation procedures, fair grievance procedures and also practicing more respect for privacy and confidentiality. And there were developed nine directions that would improve activities of managed care organizations. The first one is about continuing transition from inpatient to outpatient services, as this step would reduce costs for providing mental health services, as there is little evidence that inpatient treatment is more effective then outpatient and costs for providing outpatient services are much less. The second hint refers simplifying managed care and medical bureaucracy- less administrative work- less expenses. The third advice concerns constant investments in the research. Even though such investments are long-term ones and will not be paid back immediately, they are essential driving part of contemporary managed care. The forth hint concerned removing control of health insurance from employers. The fifth advice is about having enough supportive staff at the managed care companies, so that each staff member was doing his or her particular job, there were no overlapping job responsibilities and no staff deficit. Traditional labor strategies are also firmly advised to be considered as well as offering managed care to the educational programs and giving students the opportunity to receive practical experience. Managed care professionals should be politically active and participate actively in lobbing laws and regulations about managed care. And finally counseling professionals should stay informed about all changed occurred not only in their organization, but also from outside (professional newspapers, journals, web-sites, etc.). It is very helpful to share own experiences, successes and problems with other specialists and to hear their opinions, acknowledging something new and constantly improving professional skills.
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