Talk:Managed care
From Wikipedia, the free encyclopedia
Overall, this page does not focus on the successes of managed care or the reason why healthcare costs are rising. Managed care was actually quite successful at reducing healthcare costs at several points in the past few decades, however it came at the expense of people being denied access to care and medicines they believed they needed. Healthcare costs are rising because the "tool kit" available to patients is much larger than it used to be. Health insurance corporations are simply a financing mechanism that spread risk among the insured, thereby allowing health plan members to access care that would otherwise be too expensive to most individuals. While its true that there are many opportunities to improve coverage and access Managed Care and HMOs should not shoulder all the blame. Nor should all their ideas be discounted simply because wholesale failures in the current system. To do so would be throwing out the proverbial baby with the bath water. Any answer will have complex implications. It will mean trade-offs between increased taxation, reduced choice, reduced access, and increased out of pocket costs. The so-called single-payer systems in Canada and parts of Europe are not the panacea many in the US believe them to be. In fact, in Canada and other "single-payer" systems the government provides a full-coverage safety net, however individuals of means purchase supplemental insurance, seek care at private institutions or abroad and pay out of pocket to improve their access and selection. The US needs a better safety net, but a full single payer system is unlikely to work.63.166.14.2 20:31, 26 March 2007 (UTC)
Actually, the removed section below is relatively accurate for "staff model" HMO's. There are a variety of models, incuding so-called "staff models" where the HMO has employees; the Independent Practice Association ("IPA") and even "mixed" models. In fact, many of the seemingly "staff" models like Kaiser are really a conglomeration of contracted legal entities. For example, in CA where physicians must either contract as an independent contractor or be employed only by another physician or a governmental entity, Kaiser physicians are employed by a Kaiser physician's group which contracts with Kaiser. Kaiser hospitals are separate from the physician's group. In IPA type models, sometimes individual physicians contract with the IPA, or sometimes the physicians form a group, and the group contracts. What is at issue is how much financial risk each entity bears for the cost of providing care. The article is inaccurate in that even staff models may have satellite clinics throughout a region.
I removed the following section. I am confident that HMOs do not necessarily employ the health care providers: Look at Health Maintenance Organization, under "Types of HMOs" for various models; also, it doesn't match my experience. I don't know enough to rewrite it, but I know it's incorrect.
Physicians, nurses and other healthcare providers on the staff of HMOs work as salaried employees. They are generally housed at a central office location, rather than seeded throughout the community. They render care according to guidelines established by the corporate managers of the HMO, and may receive additional instructions in specific cases. The nature of these guidelines and instructions are invariably to provide the least costly and uncomplicated form of care for patient diagnosis, which is usually made on the basis of the least costly diagnostic procedures, moving to more costly procedures only as a last resort.
Caveat: I'm new to this and this is my very first edit ever, so please assist me by further editing and/or feedback if you can.... I changed this: "under which they agree to capitate their fees at a level approved by the insuror". to "under which they agree to accept the reimbursement that was negotiated at rates agreed upon between themselves and the insuror at the time of execution of the contract". I may revise this to be more concise - and some other things, but capitation is not used in the correct context here. Capitation, in the healthcare setting, refers to a system of a flat reimbursement to the provider for each member in the capitated group, regardless of whether any particular member seeks services for the duration of the capitated arrangement, usually monthly. It's a somewhat confusing concept to folks who are not familiar with it in a healthcare environment. Also the edit above is correct, many HMO providers these days are NOT employed by the HMO (Kaiser, quoted as an example of an HMO in the article, generally, is an exception to this). Houmantx 06:18, 13 December 2005 (UTC)
[edit] This article needs work....
Much of the information, particularly under the "HMO" section, is incorrect these days. HMO's are far less strict than previously, and many now have an "open access" option whereby a selection of a gate-keeper, or PCP, is no longer required. In fact, they are indistinguishable from PPO plans. I will work on this when I have time, or somebody else please do it. I just hate to see incorrect information here! If a grade-school student had to write a paper on managed healthcare and relied upon this information, they would flunk!! 00:01, 30 April 2006 (UTC)
[edit] NPOV
Besides the criticisms levied above (namely, that the article reflects an out-of-date perception of the healthcare system), this article has NPOV problems. In particular, the article attempts to place all of the blame on problems with the system on health insurance companies, accusing them of malice and anticonsumer behavior while ignoring any benefits to managed care (in particular, lower prices). Oftentimes, such as in the article's discussion of medical inflation, when the reality doesn't match the authors' viewpoint, the article just makes up analysis.
Overall, this page needs a serious rewrite. Cheers, Vectro 16:34, 18 January 2007 (UTC)
---you're right Vectro, we should also include a nice NPOV objective listing of the rapidly increasing salaries of insurance executives.
