The cost of healthcare is becoming a challenge for many healthcare systems. Those who manage the economics of healthcare are being haunted by the dilemma on which services to scale down and which criteria to use for this. Healthcare sectors have been scooping huge funds of the government expenditure for a long time. The concern has been raised in order to cut unnecessary expenditures on healthcare. Recent research that was done by Young (2012) shows that America was considered to be the only country that spends much money in medical care as compared to other industrialized countries, but the quality of the healthcare in the country still lags behind. Higher and higher costs of healthcare have been attributed to the use of potentially wasteful, inefficient, and unnecessary medical services. The quality of healthcare in America is wanting regarding on how chronic diseases are being handled. The patients with chronic diseases such as hypertension, heart disease, and diabetes usually do not receive proven and effective treatment such as drug therapy or self-management services to help them more effectively to manage their poor health conditions.
Any recent reform in healthcare should seek for including cost containment measures. Such measures can include lowering the length-of-stay and doing away with nonessential procedures. Healthcare financial managers should be keen to hold accountable those who might be involved in funds embezzlement through improved documentation. It should be noted, however, that cost containment measures on healthcare can be both good and disastrous. The measures can negatively impact the quality of care received by patients if these measures will mean minimizing some services like reducing the time taken in healthcare centers by patients; it might also lead to incomplete recovery-discharges on the basis of giving a chance for other patients. The paper analyzes whether trying to reduce the costs of healthcare will affect the quality of it.
Analysis
Containment of Healthcare Costs
The cost of healthcare is becoming a challenge for many healthcare systems. Those who control the economics of healthcare are being subjected to the dilemma on which services to reduce costs and what criteria to use. The United States has the most expensive healthcare system in the world because it is domineered by the private sector, and the government only comes in to negotiate for cost reduction. This has daunted many people, and, as a result, many lives are being lost. The country has a very high mortality rate, and if better mechanisms are not employed in this sector, then the situation may worsen. This is especially common to insure, uninsured, and underinsured Americans who cannot access healthcare services easily in case of health complications.
Also, most of the physicians tend to subject their patients into routine screening and treatment that some of them do not even require and might be poisonous to the health of the patient. Managed care can be very efficient if controlled well. Conversely, people have to develop the right attitude towards managed healthcare. This type of care should not just direct all the steps any person has to take in order to acquire good health services; rather, they should be developed to give the person right to choose when people view themselves as though they are in control of their health.
Managed Care
The quality of care is one of the major focuses of the field of healthcare. It indicates how well the institutions of care are managed. Managed care has been defined as a healthcare system consisting of strategies aimed at reducing costs and spreading the risks amongst insurance companies and employers. Managed care is a system that has been employed by the United States to provide quality healthcare to its citizens at a lower cost. This has been done through special organizations called the Managed Care Organizations (MCOs). This system was established to ensure that healthcare is accessible to all citizens and that cost should not be a hindrance to good health. Managed care comprises of Health Maintenance Organization (HMO), Independent Practice Association (IPA), Preferred Provider Organization (PPO), Point of Service (POS), and Private Fee-for-Service (PFFS). HMOs settle the health of individuals who are part of their network. The physicians employed for care are also part of it.
The risk is bestowed on the individual, employer, or an insurance firm. Payments are done monthly, and referrals are officiated by PCP. PPOs encompass risk sharing to downside or upside. The patient pays after the services are delivered at a discounted rate. The healthcare provider can be a member of the team or can be self-employed. All referrals are maintained within the network. Managed care lays down all guidelines that control the standards and practices of healthcare providers. It also comes up with programs and undertakings that improve the quality of services. All the records about those who use the services should be kept and presented annually.
How Acceptable Quality of Healthcare Can Be Assured for All
An acceptable quality of healthcare can be assured to all citizens of the United States only if the patients receive a comprehensive range of services that would ensure not only the adequacy of the care but also the efficient quality of care. Since the health needs of patients differ from each other, there is a need for developing a system that would be beneficial to everyone. To ensure that the patient receives high-quality healthcare, there are several things that must be considered as essential ones. For instance, the cost of healthcare, medical technology, and the credentials of the physicians chosen to render services to patients may be among these issues.
Concerning the cost of healthcare, there are many insurance companies that are collecting more money in terms of premiums to cater for the cost of healthcare for all the employees in the country. However, they pay less in for the services that they render to their members. Since the cost of health insurance is the major factor that determines the accessibility of citizens to hospitals, there has been a rise in the cost of health insurance. This has made more consumers go without coverage hence derailing the need for improving the quality of healthcare in the country. Therefore, the harmonization of the cost of insurance coverage to all citizens in the county is needed so as to make sure that everyone has such his/her health insurance cover that will denote that all the people have access to high-quality healthcare in the country.
Concerning medical technology, it can be used to improve the management of chronic diseases such as cardiovascular disease where coronaries that are artificial tubes can be used to keep the arteries open in case of coronary heart disease. This might reduce the number of patients who die almost daily as a result of a heart attack. Finally, medical technology can be used in reducing the hospital stays of patients by shifting from inpatient to outpatient care services that provide substantial cost savings as well as improve the quality of life of patients. For instance, the cataract surgery, that was initially performed and required the patient to stay in the hospital for about five days, can be improved nowadays so as to allow shorter hospital periods and better services. The quality of healthcare can also be improved if the physicians who provide health services are competent and excellent in their profession. A well-trained physician is critical to providing high-quality care with desirable outcomes. This is because they understand on how to diagnose and identify the diseases that patients suffer from before they can provide treatment for these diseases, thus eliminating the possibility of patients getting unnecessary treatments that might endanger their lives.
Medical technology is considered to be improving the quality of medical care because it is important in extending and improving the lives of humanity by alleviating injuries and pain that patient might experience as a result of an accident by the use of various medical technologies.
Will Containing Costs Hurt the Quality of Care?
Managed care systems in various healthcare institutions help individuals to understand the ethical and moral principles of the services offered. The art of managed care is dependent on the relationships between patient and service provider. Managed care focuses on the quality of healthcare, access, and cost. In as much as individuals want high-quality healthcare services, there must be considerations for the costs and access. Not every individual in the hospital has the ability to afford services offered there. Special considerations must be made in order to accommodate every single individual and to make them able to enjoy similar services equitably. In the past, managed care systems in some healthcare institutions have been influenced by commercial interests as well as by the legislation. However, current managed care is influenced by decisions made on grounds of affordability, quality, and accessibility. Managed care is meant to address issues of affordability, access, cost, and effectiveness of the care. Consequently, the managed care organizations lead to appropriateness through the financial incentives and utilization as well as quality assurance programs.
Preservation of the doctor-patient relationships in healthcare institutions is fundamental in ensuring managed care. In as much as both the physicians and patients depend on the healthcare institution for sustenance, the physicians have more rigorous tasks of ensuring advocacy for the institution as well as for the patients. The physician’s duties are considered pivotal in ensuring that the patients are properly managed. However, the former tend to advocate for the healthcare institutions for the returns. Managed care has been trending in the recent past. Institutions tend to expand on their approaches and strategies in terms of ensuring managed care. Even though managed care helps both the healthcare institutions and the patients, it may lead to depriving individuals of their ability to make choices.
Ethical concerns have been raised in the recent past concerning the way managed care is conducted. Challenges are experienced where there is autonomy professionalism whereas funding healthcare services is also problematic. It is often a challenge to make proper clinical decisions versus the financial issues that a patient or an institution undergoes. Healthcare institutions must always mitigate financial issues often faced during their service provision. This does not call for financial intimidation of the patient. Various healthcare institutions must also understand the financial situation of their clients. It is believed that the costs of the care are not related to the decisions made during the managed care. Such kind of care issues a lot of challenges. The physicians do not only ensure that the patients get high-quality care, but they also ensure that the institutions gain from the services they offer to the patients. Physicians have a hard task of mastering all the incentives. Thus, this may pose many threats to their concentration and service delivery.
Patients need to get the quality care that must be balanced between the patient and the care provider. In a real-life situation, managed care has a lot of challenges despite the fact that it ensures high-quality care and financial freedom for the patients. High-quality care is one of the major reasons for nursing care in most of nursing institutions. Such care is often ensured through the application of rigorous and intensive care by nurses and other healthcare providers. The healthcare reform ought to help people in accessing affordable healthcare as well as in getting quality healthcare services. Healthcare financing by the organizations ensures that many citizens who are unemployed or get low income can access medical services offered by the healthcare givers. The poor, elderly, the children, and the disabled people can get good health services regardless of their ability to pay. IT is the major tool that has improved quality and efficiency of healthcare delivery as it managed issues that arise in the relationships between healthcare providers and managed care organizations, including fee negotiations, adjudication claims, termination, contract reviews, and breach of contract actions.
Healthcare management is among the challenging areas of control in modern society. However, with good management in place, the challenges created by the sensitive nature of healthcare management can be well managed in order to ensure good services to all. Healthcare management is expected to maintain an upward or improving trend regarding service delivery and response to various situations.
Opinion and Conclusion
High spending is always interlinked with high quality. American health services are very dear and call for a lot of spending. American healthcare is the most expensive one in the world, yet in comparison with other countries, it is not of respectively good quality. The health insurance premiums are so soaring leading to inaccessibility to healthcare by the poor. Health is vital and should be availed to all irrespective of their financial status. Although the purpose of managed healthcare is to ensure that healthcare services are accessible to every member of any society, it is normally impossible to achieve this goal. There are specific factors that are often covered in the universal healthcare system. It is usually concerned with the covered, the services, and the cost of the services. There is strong advocacy for universal healthcare services for all individuals in society.
Many people have argued that containing costs will hurt the quality of care given to patients. Though this may be true, one may wonder why the quality is still not the best, yet the cost of healthcare is already very high. In no way, containing healthcare costs will hurt the quality of care as this is just a myth created by the pure capitalists who are only interested in making profits. The cost of healthcare should be managed by the government with proper policies that will ensure that quality is not compromised.
The Medicare programs have been instrumental in terms of aiding in cutting the costs in healthcare facilities by limiting the access of patients in terms of providing the so-called ‘gatekeepers’ who ensure that it is only patients with serious cases who are sent to such facilities. However, care and caution should be primarily placed to ensure that the freedom of the patient is not curtailed by the gatekeepers in terms of restricting the patients from seeking for the services of their preferred physicians. Lastly, when it comes to healthcare, quality should not be an option. Therefore, with the tremendous growth in Medicare programs and with the emergence of many providers, every step should be taken in order to ensure that high medical standards are set in place and the patients do not fall victims of unethical providers.
