The U.S. Health Care System is frequently criticized as being expensive and lacking coverage of the total population. On the other hand, the U.S. Health Care System is innovative and frequently used by foreign residents for treatment. Managed care was a response to the cost, quality and coverage concerns. Consider the issues of care coordination, prevention practices, formulary medication costs, delay in getting appointments or tests, denial of referrals to specialists, inadequate skill of physicians and the need for specific approval by an MCO before the most effective medication for the treatment of a condition can be obtained if the drug is not listed in the plan's formulary. Assume a position either for or against managed care.
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I oppose the managed care system for a couple of reasons.
(a) People can’t really get the best care from abundant sources when both the doctors and providers are in cahoots to spend less monies in the least amount of time as possible per patient.
Complementary and Alternative Medicine (CAM) is the abundant source I mentioned. Most people pay for CAM therapies out-of-pocket, because pharmaceutical companies have a monopoly on how patients are treated, and they are concerned that CAM will become the “new” low-reimbursement insurance coverage therapy (Cuellar, 2006).
Many health care consumers are advocates of the holistic abundance. It somewhat subjugates the need for expert opinions or special access to manufactured medicines as the effects of CAM are anecdotal, meaning based on word of mouth, and herbs and berries grow freely. Therefore, some physicians are uncomfortable with CAM and the idea of the empowered patient. If they are planning to add CAM to medical practice, conventional providers must identify how they will prepare for a shift to CAM integration. However, not all HMOs have fully embraced the concept of routine reimbursement for Complementary and Alternative Medicine care, and that is a key concern in the future of integrative medicine (Cuellar, 2006).
(b) In managed care, the healthy people pay for the treatment of the ill, and it is a risk for providers if the amount the group that paid for a certain contract was maximized by the patients in treating the case of pre-existing conditions such as cancer or other illnesses that require frequent doctors visits and expensive medications. Because individuals with chronic illness or disability may also experience medical complications and need a variety of allied services such as home care, personal assistants, or consultation with medical specialists, costs can be further increased for these individuals (Falvo, 2008). With this aspect of managed care, the need for specific approval by an MCO before the most effective medication for the treatment of a condition can be obtained is another downside.
Two suggestions I have for enhancing managed care for chronically ill clients are (a) ending the monopoly on the food supply while educating the public more about preventative care and also (b) as Hippocrates said, “Let food be our medicine and medicine be our food.” In the name of modernization and conveniences we have either overlooked the importance of quality of our food (Charania, 2012). Many conditions such as cancers, depression, ADD, anxiety, addiction, and many more are the result of a poor nutrition.
Society’s values influence provision and payment for health services in (a) what parents teach their children to do in the management of the health of themselves and (b) the labeling foods that are produced with genetically modified organisms (GMOs). Promoting abundant, organic foods will improve quality of life for everyone.
Photo credit: No GMO South Africa & Healthy Holistic Living
According to Jeremy Gernand of True Progress, our agricultural capacity to produce food, clothing, and shelter at the standards of the western world can accommodate nearly 12 billion people. We are only 7 billion, and the only reason some must do without is the structural violence of them not having enough monies to pay for the goods. It’s anti-economics and makes for poorer public health.
References
Charania, B (2012). LET FOOD BE THY MEDICINE – Hippocrates. Retrieved from http://www.drcharania.org/2012/01/food-thy-medicine-hippocrates/
Cuellar, N. (2006). Conversations in Complementary and Alternative Medicine: Insights and Perspectives from Leading Practitioners (1st ed). Jones & Bartlett Learning.
Falvo, D. (2008). Medical & Psychosocial Aspects of Chronic Illness and Disability (4th ed). Jones & Bartlett Learning.
Gernand, J. (February 4, 2011). The Earth Can Feed, Clothe, and House 12 Billion People. Retrieved from http://true-progress.com/the-earth-can-feed-clothe-and-house-12-billion-people-306.htm
(a) People can’t really get the best care from abundant sources when both the doctors and providers are in cahoots to spend less monies in the least amount of time as possible per patient.
Complementary and Alternative Medicine (CAM) is the abundant source I mentioned. Most people pay for CAM therapies out-of-pocket, because pharmaceutical companies have a monopoly on how patients are treated, and they are concerned that CAM will become the “new” low-reimbursement insurance coverage therapy (Cuellar, 2006).
Many health care consumers are advocates of the holistic abundance. It somewhat subjugates the need for expert opinions or special access to manufactured medicines as the effects of CAM are anecdotal, meaning based on word of mouth, and herbs and berries grow freely. Therefore, some physicians are uncomfortable with CAM and the idea of the empowered patient. If they are planning to add CAM to medical practice, conventional providers must identify how they will prepare for a shift to CAM integration. However, not all HMOs have fully embraced the concept of routine reimbursement for Complementary and Alternative Medicine care, and that is a key concern in the future of integrative medicine (Cuellar, 2006).
(b) In managed care, the healthy people pay for the treatment of the ill, and it is a risk for providers if the amount the group that paid for a certain contract was maximized by the patients in treating the case of pre-existing conditions such as cancer or other illnesses that require frequent doctors visits and expensive medications. Because individuals with chronic illness or disability may also experience medical complications and need a variety of allied services such as home care, personal assistants, or consultation with medical specialists, costs can be further increased for these individuals (Falvo, 2008). With this aspect of managed care, the need for specific approval by an MCO before the most effective medication for the treatment of a condition can be obtained is another downside.
Two suggestions I have for enhancing managed care for chronically ill clients are (a) ending the monopoly on the food supply while educating the public more about preventative care and also (b) as Hippocrates said, “Let food be our medicine and medicine be our food.” In the name of modernization and conveniences we have either overlooked the importance of quality of our food (Charania, 2012). Many conditions such as cancers, depression, ADD, anxiety, addiction, and many more are the result of a poor nutrition.
Society’s values influence provision and payment for health services in (a) what parents teach their children to do in the management of the health of themselves and (b) the labeling foods that are produced with genetically modified organisms (GMOs). Promoting abundant, organic foods will improve quality of life for everyone.
Photo credit: No GMO South Africa & Healthy Holistic Living
According to Jeremy Gernand of True Progress, our agricultural capacity to produce food, clothing, and shelter at the standards of the western world can accommodate nearly 12 billion people. We are only 7 billion, and the only reason some must do without is the structural violence of them not having enough monies to pay for the goods. It’s anti-economics and makes for poorer public health.
References
Charania, B (2012). LET FOOD BE THY MEDICINE – Hippocrates. Retrieved from http://www.drcharania.org/2012/01/food-thy-medicine-hippocrates/
Cuellar, N. (2006). Conversations in Complementary and Alternative Medicine: Insights and Perspectives from Leading Practitioners (1st ed). Jones & Bartlett Learning.
Falvo, D. (2008). Medical & Psychosocial Aspects of Chronic Illness and Disability (4th ed). Jones & Bartlett Learning.
Gernand, J. (February 4, 2011). The Earth Can Feed, Clothe, and House 12 Billion People. Retrieved from http://true-progress.com/the-earth-can-feed-clothe-and-house-12-billion-people-306.htm
Instructor's comments:
Thank you for your hard work in the discussion area this week. You mentioned many great points relating to the challenges of managed care. Great connection of managed care to Complementary and Alternative Medicine and the apprehension of physicians to fully endorse this. When we view this from the physicians perspectives is it really about physicians being uncomfortable with empowered patient or should we explore other reasons? You, however, presented a great argument and helped to see managed care from a different lens. This helped us to understand the various challenges presented by the system of managed care. You mentioned a great point relating to educating the public about healthy foods and preventive care. Education and preventive care are critical in reducing many chronic diseases. Great work!
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