Question & Answer: Health care questions- Please select 5 questions and answer in depth……

1. What are some of the key differences between traditional health care insurance and managed care?

Some of the key differences between traditional health care insurance and managed care are following-

• The managed care emerges as the important form of health care delivery because the medical cost is significantly lower in managed care than traditional health care.
• Through managed care, now the health care services are becoming affordable to many people otherwise it was out of their reach.
• With increasing number of Medicare insurer, the managed care becoming more competitive and passing the benefits to its customers in the form of reduced cost of health care services.
• The quality of services is also improving because of the extensive use of information technology in the health care and claim settlement.
• The managed care has benefited the consumers from improvement in overall health care services and value for money.

2. How quality of care entered the managed care arena?

The quality of services has improved in managed care arena because of the extensive use of information technology in the health care and claim settlement.

3. What was the purpose of health maintenance organization act of 1973 fail to achieve its objective? What happened by end of 1990?

The purpose of health maintenance organization act of 1973 was to control the cost of health care services, assure the quality care services and easy access to health care services.

The Health Maintenance Organization Act of 1973 encouraged the development of HMOs with financial assistance and contacts, loans etc. where HMOs were legal entities to provide basic health care services for pre-paid fees. The HMOs failed in their purpose due to their financial viability and their ability to meet the goal as they completed only approx. 10% of the targeted HMOs and population.

By end of 1990, most HMOs were operated through managed care organizations with different lines of business used in the network model. In network model, HMOs can contract any combination of groups and individual physicians for their service.

4. Discuss the concept of utilization, monitoring and control?

Managed care services use various methods to monitor and control utilization of services. Utilization management requires the followings –

• An evaluation of the basic medical services that are necessary
• Finding the method that how these services can be made cost effective without compromising on its quality.
• An assessment of the method of medical care and the impact on the patient’s health condition to analysis and revise the process if required.