Managed care and trend analysis Research Paper Introduction
The provision of health care services as well as its financing is to a large extent directed by Managed care systems. These systems were started with the sole intention of creating an integral, cost effective healthcare system. The unfavorable economic environment has put a strain on individuals` finances and resulted in a rapidly shrinking number of people enrolled in managed care systems.
The trend analysis reveals a steady rise in healthcare costs over the years. This could be due to the increased demand for healthcare services and technological advancements that have availed new, sophisticated but expensive treatments. The trend analysis also shows a rise in unemployment rates, a phenomenon has dealt a blow to managed care systems by limiting the numbers enrolled. Healthcare reforms expanded individuals’ coverage accessibility. Unemployment trends also drive managed care through controlling the number of individuals enrolling for coverage. Today, managed care is experiencing certain trends and issues.
The trends that will be expounded on in this paper are the increasing unemployment rate, the rising costs of health insurance and the declining rate of enrollment Health Maintenance Organizations (HMO’s) and Preferred Provider Organizations (PPO’s).These three trends were selected because of their significant impact on the healthcare system .
High Costs of Health Insurance
The fact that healthcare insurance costs have sky rocketed is undisputable. This has resulted in Americans refraining from utilizing managed care services as the costs are way out of reach for most people. The high costs have become a cause of concern with stakeholders predicting that they may still go higher. This brings one to question the core principles guiding health insurance wondering if they are tailored to the needs of everyone in the society especially those who do not possess a vast amount of material wealth (Scholes et al., 2012).
The fear of the repercussions on the new impeding laws governing managed care services has also led to the escalated costs. With the managed care service providers anticipating the changes that the new laws will impose on their operation, prices were deemed to go up because operators naturally had to look for means to protect their interests. Defending their decision to escalate cost, the operators said that the new regulations would have a momentous impact on the business operating environment and present them with new challenges that required them to utilize their resources to tackle them.
The new guidelines also dictated that preventive measures for life threatening diseases like cancer be implemented. This gave rise to the need of regular screening and health checkups to ascertain that one did not run the risk developing a terminal illness. The laws also introduced insurance services for young children thus changing the dynamics of the healthcare business and necessitating the price increments the services hitherto offered at a more affordable rate (Trivedi, Zaslavsky, Schneider, & Ayanian, 2005).
The economic downturn has not spared the health insurance sector. High levels of inflation and rising costs of commodities caused insurance costs to shoot up negatively affecting people who were already grappling under the weight of the heavy financial burden of day to day living. This makes cost cutting an inescapable survival technique and health insurance was amongst the first to be affected. Employers react to this harsh economic environment by drastically reducing the amount of money spent on employee insurance and in some cases suspending health cover altogether. Low wage earning employees are especially prone to feel the full force of this decision and will in most cases miss out on the benefits of health insurance thus reducing their likelihood of using managed care services.
Health Maintenance Organizations (HMO’s) and Preferred Provider Organizations (PPO’s)
When HMO’s and PPO’s were analyzed side by side, PPO was the popular choice with a noticeably larger number of enrollments than the former. The two organizations play a critical role in managed care services and through their combined efforts they are accredited with providing health insurance cover to millions of Americans. The mission of these two organizations is to provide to their members access to healthcare services at reduced charges as per prior arrangements. However, HMO`s and PPO`s are not new to challenges especially those stemming from low rates of enrollment as has been the trend. This greatly affects their operating efficiency and consequently leads to increased managed care costs.
Reforms to be brought about by the new laws are a cause of hope to Americans and managed care services. There have been talks of healthcare restructuring so that more people are able to access healthcare services. This will result in a larger percentage of the population being able enroll and maintain their membership in managed care programs. The managed service providers with renewed hope have developed new strategies to respond to the future prospects of improved business conditions as they prepare to offer managed care services to all members of the population.
When achieved, the concept of universal healthcare will be an important milestone that will lead the nation towards better health and reliable healthcare solutions when illness rears its head. With increased enrollments, the managed care services will be able to function at optimum efficiency adequately fulfilling the purpose for which they were established.
High unemployment rates
The high rate of unemployment largely caused by the economic decline is quickly becoming a scourge that is threatening the healthcare sector and needs immediate attention before it spirals out of control (Fleming, Lien, Ma, & McGuire, 2003). More and more people are losing their jobs every day because their employers feel the need to cut down on the compensation budget in a bid to fight off the negative effects of the economic slump. These people left without jobs cannot afford support themselves leave alone paying for health insurance and yet they require the services health practitioners from time to time. Caught in the middle of this sad state of affairs, managed care services are struggling to thrive in spite of the numerous challenges presented. Many small firms are opting against making health insurance contributions for their employees in order to escape the high costs associated with managed care. It is worth noting that many of the employed individuals are looking for ways to cut on costs by minimizing their healthcare insurance premiums with some choosing to remain uninsured though this is not advisable. This means that a large number of the population is not able to utilize the managed care services simply because they are not able to afford them.
In an attempt to ward off this problem, managed care service providers have come up with ingenious ways to capture the attention jobless and low income earners by designing attractive health insurance plans that meet their needs bearing in mind their limited financial ability. Some of the benefits of these plans include access to preventive care as well as primary healthcare insurance (Trivedi et al., 2005). This is aimed at gradually curbing the number of uninsured members of the population thus steering them to a more secure living.
Managed care services have been the victim the harsh economic climate thus experiencing a myriad of challenges that have undermined their effectiveness. The major challenge has been the reduced number of enrollments as people try to cut back on costs associated with these services.
The health insurance costs have shown from the trend analysis to be progressively escalating. This has also dealt blow healthcare services because the restrictive costs have locked out a large number of people from enjoying insurance benefits and a notable percentage of the population is uninsured.
Despite the worrying trend decreasing numbers of managed care enrollments, its importance cannot be overlooked. There is hope that with improvements in the economic status due to take place in the future, some of the challenges facing managed care systems will be resolved because when the economy is flourishing, more individuals will be able to find jobs averting the current trend of increasing joblessness and thus will be able to make their health insurance payments (Rodvold, 2009). More firms will also be able to afford making insurance payments for their employees.
The new reforms provide some hope that healthcare services will become much more readily accessible to all people in the near future. This will be an unforgettable time because the fundamental building blocks of any successful nation is a healthy population and when the country attains this, then it can be said to be on its way to great economic and social prosperity.
References on Managed Care and Trend Analysis Essay:
Fleming, E., Lien, H., Ma, C. T., & McGuire, T. G. (2003). Managed care, networks and trends in hospital care for mental health and substance abuse treatment in Massachusetts: 1994-1999. J Ment Health Policy Econ, 6(1), 3-12.
Rodvold, K. A. (2009). Journal of Managed Care Pharmacy. START (Stewardship Tactics for Antimicrobial Resistance Trends). Introduction. J Manag Care Pharm, 15(2 Suppl), S3-4.
Scholes, D., Satterwhite, C. L., Yu, O., Fine, D., Weinstock, H., & Berman, S. (2012). Long-term trends in Chlamydia trachomatis infections and related outcomes in a U.S. managed care population. Sex Transm Dis, 39(2), 81-88. doi: 10.1097/OLQ.0b013e31823e3009
Trivedi, A. N., Zaslavsky, A. M., Schneider, E. C., & Ayanian, J. Z. (2005). Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med, 353(7), 692-700. doi: 10.1056/NEJMsa051207