Managed Care Delivery

1 . How do managed business make-up organizations provide extensive and musical none make do while retentiveness cost downAmerican health alimony should essentially be a nonprofit enterprise except , the privatization of American health circumspection holds that health accusation in general and hospitals in ill-tempered atomic number 18 increasingly operating(a) on a for-profit basis . In fact , the for-profit hospital sector has accounted for a relatively eonian share (about 15 percent ) of hospital beds over the suffer twenty years (Morrisson , 1999 . This is why recently the U .S . carnal knowledge tries to push more consumer-directed health plan options to avoid cash-strapped managed care organizations (MCOs ) to boost their deductibles , cram gifts and even defy federal righteousness by authorizing insuranc e holders to buy prescription drugs from low-cost vendors in Canada (Smith , 23 family 2004Managed care organizations (MCOs ) frequently apply the traditional fee-for-service models , which do not provide adequate financial controls and utilization bonuss for physicians and hospitals to tick off the costs of providing healthcare . Under managed care , the needs of the patients are balance with efforts to provide cost-effective care Typically , MCOs register subscribers by promising to provide all required aesculapian care in central for a fixed monthly superior . The MCO also contracts with hospitals , physicians , and other healthcare providers to dispense the necessary health check care to its enrollees at a discounted reimbursement rate . In exchange for accepting reduced fees , the caregivers gain access to the MCO s enrolees (Kirby , Sebastian Hornberger , 1998A riddle with managed care is that employers who offer a health maintenance organization (health maintenance organization ) to their employees often pay ! the agiotage as long as the HMO premium was not higher(prenominal) than the fee-for-service premium . This behavior by employers creates distorted incentives for the HMO in controlling its costs . Enthoven (1993 ) suggested that this incentive distortion can be corrected when employers design soften alternatives for their employer contributions .

The employer could contribute a fixed-dollar beat for health insurance with the employee gainful the full discrepancy in the midst of plans . The greater the portion of the bare(a) premium paid by the employees is , the stronger the incentive is to choose lower-cost p lans . For good example , if the employer pays 80 percent of the premium and the employee pays the remainder , then the employee pays exactly 20 percent of the difference between the low (let s simulate here ) HMO premium and the higher fee-for-service premiumHMOs and other managed care ar effigyments are organized on a prepayment basis that pop in a big variety of forms . An HMO could wage physicians on a net income , contract with a be group practice of physicians , or contract with physicians who maintain a fee-for-service practice . According to Luft (1991 , Because particular social , legal historic , political , and economic aspects of the medical care environment curb shaped delivery systems such as the HMO , it is not reasonable to expect that the regular(prenominal) HMO could be transplanted entire to another country (p . 173The headstone to HMO cost savings is the organization s wide range of medical services , twain inpatient and outpatient . In this right smart , the HMO can...If you want to desexualise a ! full essay, rove it on our website: OrderCustomPaper.com

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