Health Care Delivery System Essay
In the past, managed care in the United States took the form of voluntary programs. Such programs date from about 1850, when managed care was provided chiefly by cooperative mutual benefit and fraternal beneficiary associations. Limited coverage by commercial companies was also introduced during that period, and subsequently many plans were established by industries and labor unions. Advocacy of government managed care in the United States began in the early 1900s.
Theodore Roosevelt made national managed care one of the major planks of the Progressive party during the 1912 presidential campaign, and in 1915 a model bill for managed care was presented, but defeated, in numerous state legislatures. After 1920 opposition to government-sponsored plans was led by the American Medical Association and was said to be motivated by the fear that government participation in medical care might lead to socialized medicine. Birenbaum, 1997) Over the years in the United States, many plans have been set up by societies of practicing physicians, but the largest enrollment has been in Blue Cross and Blue Shield plans. These were set up as community-sponsored, nonprofit service plans based on contracts with hospitals and with subscribers. Most general voluntary plans accept subscribers, in groups or as individuals. These plans extend coverage to dependents and exclude accidents and diseases covered by workers’ compensation laws.
Although valuable in cushioning the financial distress caused by illness or injury, voluntary managed care not only limits benefits in order to avoid prohibitive rates but also excludes many people, particularly the poor, who cannot afford it, and senior citizens, for whom the cost is often prohibitive. By the mid-1990s many of the Blue Cross companies, which had been suffering financially, were reorganizing, and by 2002 more than 20% of Blue Cross members were covered by plans that had converted to for-profit status. (www. medicare. ov) During the middle of the 20th century it became apparent that legislation was necessary to provide medical care for the elderly. A voluntary federal-state grant-in-aid program providing medical care to the elderly was first implemented in 1961. Legislation proposed by President Kennedy to provide medical care for the aged through the social security mechanism was defeated in 1961, but in 1965, during President Lyndon B. Johnson’s administration, Federal legislation in the form of Medicare for the aged and Medicaid for the ndigent was enacted. Since 1966, both public and private managed care has played a key role in financing health-care costs in the United States. Over 70% of all medical bills are now covered by government programs and insurance, and the number of people covered by some form of managed care increased from about 12 million in 1940 to over 225 million in 1996. About 38 million Americans were enrolled in Medicare, and there were more than 36 million Medicaid recipients.
In that same year, about 187 million people were covered by private health insurance. However, more than 44 million Americans are not covered by any health insurance, and those who are have seen significant cost increases. As premiums increased from $16. 8 billion in 1970 to $310 billion in 1995, and national health-care costs rose from $75 billion in 1970 to just over $1 trillion in 1996, many businesses increased the amount of money employees contribute toward their health insurance.
This situation has led to continuing political pressure for restructuring of the national health-care insurance system. (www. medicare. gov) Congress debated many bills for a national managed care plan in the 1960s and 70s, and in 1973 it passed the Health Maintenance Organization (HMO) Act, which provided grants to employers who set up HMOs. Unlike insurers, HMOs provide care directly to patients; HMOs were viewed as low-cost alternatives to hospitals and private doctors. In 1997 approximately 651 HMOs provided care to 66. 8 million people.
In the 1980s and 90s political leaders again advanced a variety of national managed care proposals. There has been to date really limited empirical assessment of the impacts of these laws. One plan backed by leading Democrats was known as “pay or play” because it would have forced employers to provide managed care or pay into a national fund that would cover uninsured workers. A second, advanced by President G. H. W. Bush in 1992, would have provided tax breaks, vouchers, and other incentives to employers to extend managed care benefits.
A third proposal, based on the Canadian model and nationalized health care, was opposed by most doctors and the insurance industry. In 1993, President Clinton, who had been elected on a promise of health-care reform, proposed a national managed care program that would have ultimately provided coverage for most citizens, but opposition by insurance, medical, small-business, and other groups killed it. In 1999, Clinton and Congress battled over developing a “patient’s bill of rights,” to protect people from denial of service and other HMO imitations. Many individual states have developed their own managed care alternatives by using managed-health-care systems that monitor the type of services offered and have set fees for each service, by expanding Medicaid to help serve formerly ineligible patients, and by establishing statewide or small-business managed care alliances that pool people into a large group that has more buying power. (Birenbaum, 1997) References www. medicaid. gov Birenbaum, Arnold. (1997). Managed Care: Made in America, Praeger Publishers, Westport, CT.
Health Care Delivery System Essay
A health system, also sometimes referred to as health care system or healthcare system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations (wikipedia. org, 2013). The delivery system is made up of insurance companies, patients, physicians, hospitals, and other health providers.
The main goal of the healthcare delivery system is to provide quality care but still lower costs. The first component of choosing health care providers is to understand insurance. Health care is very expensive and people need to know and understand how they will pay for it.Consumers need to know if they have an HMO, PPO, POS, or other type of insurance plan.
If the consumer has an HMO plan, they are restricted to providers within their network. They are also required to obtain referrals from their primary care physician before going to see any type of specialist. PPO and POS insurance plans do have out of network benefits, however, they will pay much higher costs to see those doctors. The government plays a large role in the health care delivery system.
Last year 95 million people had government, which is 31 percent of the population of the entire United States (Stark, 2012).The Patient Protection and Affordable Care Act is a law that President Obama passed in 2010 with the intent to allow and mandate that every American citizen obtain health insurance. This law passed several regulations on insurance companies so that more Americans could get private health insurance. One of these regulations is that health insurance companies cannot deny anyone because of previous medical history.
The providers also make a part of the delivery system. Healthcare providers are institutions or individuals that provide some sort of health care service (wikipedia. rg, 2013). Individuals can be any Allied Health professional such as a physician, a pharmacist, a paramedic, a nurse, or many more.
Institutions can be any type of organization that provides health care. Some examples of health care institutions can be hospitals, nursing homes, rehab facilities, home health providers, or durable medical equipment companies.The patient is the last part of the healthcare delivery system. A lot of focus has been placed on preventative care recently.
Well patients cost less than sick patients. Many insurance companies are paying for 100 percent of reventative care because that will save them money in the long run. The health care system is still very flawed, but the government is making efforts to improve upon it. The system needs every component to function properly.
Health care costs in this country are huge and also big part of the government budget. Everyone’s goal is to work together to provide quality care at lower costs to all involved. I think that the government plays a huge role in the healthcare system. I think there are some good aspects to the Affordable Care Act but I think it will end up being very costly for American citizens.