managed care backlash

Question Description

Need help with my Health & Medical question – I’m studying for my class.

You must also respond to one of your classmates’ posts prior to Saturday night at 11:59 pm. For follow up posts, you want to add something new to what was already posted (find a case study on the topic and summarize the findings, find a research study and share the statistical findings with the class, provide a real-world example of the topic to the class, etc). The post should be at least 300 words.

(HR -For my knowledge only, disregard)

What is the managed care backlash? Are patient and provider complaints about managed care valid? Why or why not?

Managed-care is part of the U.S hospital systems and is the mechanism by which an organization takes on the management of financing, insurance, delivery, and payments ( Shi & Singh, pg. 206, 2019). The managed care backlash happened during the decade of 1990s when there was a significant headway success that then slowly went downhill due to the growth of national healthcare expenditures which is when the consumers, providers, and physicians went against the system. It was also said the American media had played a role in shaping the public opinion against the managed care by representing or sharing one side of a story rather than both sides (Shi & Singh, pg. 211, 2019). Patients would complain over “both complications and increased risk of malpractice litigation” (ECRI, 2016) and the healthcare system would have to take those complaints and try to resolve the issue on the spot if it is a minor issue and if not, then healthcare organizations would process that in a timely manner. Patient and provider complaints about the managed care backlash are and still considered valid within the healthcare system and politicians responded to these complaints by passing laws to contain some perceived excesses of care. The complaints being given by the patients and providers was a way to show the HMOs that there are still issues being made towards them and it had to be fixed in order to provide the best care and best work environment for those involved.

According to the book written by Shi and Singh, in response to the backlash and the complaints being given to the healthcare system, HMOs (Health Maintenance Plan) issued plans such as fee-for-service reimbursement, capitation for certain services, greater choices of providers, and MCOs (Managed care Organization) had to relax their controls and flexibility so that the system can work towards the greatness and content for all those involved. The providers had to agree with these changes and give up some of their own control as to how they would practice medicine and had to settle for lower rates than what they were used to and patients had to give up their freedom of choice and receive the providers that were available to them. According to research constructed by Marquis, Rogowski, & Escarce, during the post backlash in the system, only <1 dropped in the HMO enrollment. Some explanations for this small change are that many HMOs had relaxed their cost containment restrictions to help avoid losing the market ( RAND, 2021).

References

Managing Patient Complaints and Grievances. ECRI. (2016, August 17). https://www.ecri.org/components/HRC/Pages/PtSup1.aspx?PF=1&source=print.

Marquis, M. S., Rogowski, J., & Escarce, J. J. (2005, November 25). The Managed Care Backlash: Did Consumers Vote with Their Feet? RAND Corporation. https://www.rand.org/pubs/research_briefs/RB9121.html.

Shi, L., & Singh, D. A., (2019). Essentials of the U.S. health care system (Fifth ed.). Burlington, MA: Jones & Bartlett Learning.