The transition to managed care from traditional payers
In our country, 48.8 million citizens are said to have Medicare insurance and another 65 million have Medicaid (cnsnews.com). This means that a large proportion of US citizens depend on government assistance for health insurance coverage. This is why managed care is becoming increasingly popular. Managed care limits the amount of health care a person receives. These restrictions prevent patients – as well as doctors – from overspending on healthcare, which in turn reduces costs.
Many in our country cannot afford the rising costs of health care, so they desperately depend on our government to help cover these necessary costs. The problem is that the government is not where the funds come from. Taxpayers are the ones paying for this coverage. This raises the debate of whether managed healthcare is beneficial or not? One might say it’s unfair to raise taxes to cover the less fortunate, but another might think it’s unfair to place limits on necessary health procedures or supplies to save money.
The move to managed care was made to ensure that the government would assume responsibility for this coverage. They have made this “contract” so to speak with doctors and insurance companies that limits health care to citizens, making them think that free to low premiums allow them to be covered in the event of a medical emergency. Yes, restrictions are necessary in this area, but we must remember that this area deals with the lives of others.
Managed care plans put patients in situations where they have no choice but to try to pay cash for the health care they need. They allow the manager to say yes or no to care, not the doctor. At this point, the doctor has no choice but to allow the patient to pay cash for the required service, according to their contract. The doctor receives a flat fee to see patients who are in this managed care network, thus leaving no opportunity for their office to try to appeal the manager’s denial of reimbursement.
Managed care plans will continue to grow across our country not to benefit patients, but to protect the government and insurance funds. Patients will continue to see an increase in taxes, but not an increase in the quality of their care. This change has not helped in any way, it has only come into play to blind patients to what is really going on behind the scenes of healthcare.
References
1. Jeffrey B. Terence, (October 18, 2012). Enrollees in Medicaid and Medicare now outnumber full-time workers in the private sector. Extracted from http://cnsnews.com/news/article/medicaid-and-medicare-enrollees-now-outnumber-full-time-private-sector-workers
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