Health Care Reform 3

“Managed Care is a system to integrate the delivery and financing of comprehensive health care services to covered individuals by means of arrangement with selected health care providers; explicit criteria for the selection of health-care providers; significant financial incentives for members to use providers and procedures associated with the plan; and formal programs for quality assurance and utilization review. Providers of managed care include health maintenance organizations (HMOs) and preferred provider organizations (PPOs), as well as traditional insurance companies” (Chippewa County-Montevideo Hospital and Medical Clinic ). So understanding that a Managed Care system is not run by the government, it is competitive with other organizations for customers, and provides options of financing and the access to health care. The goal of managed care systems is to reduce the costs of providing health benefits and improve the quality of care. The down fall of Managed Care systems is that the criteria chosen by certain people will not always sit well with the consumers. A way to improve the HMO’s is to analyze the legitimacy of the goals of the Managed Care systems, and give more control to the public to form policies with accessing quality health care.


Who needs to act to reform the goals of the HMO’s? I feel that it needs to be a joint effort between the HMO’s and the consumers. As human beings we like to be in complete control, which sometimes can hinder us because we are not all health care specialist and do not understand the complexities of health care. Everyone strives for a better solution and the authority that HMO’s have of deciding our fate can be threatening to people’s ideas. The public, patients, and clinicians have to entrust that the moral authority that the Managed Care systems possess are going to benefit them. The HMO’s have a great task of distributing health care. Our group really supports the idea of universal health care. According to Deloitte Development increasing taxes to help provide health insurance coverage for the 47 million is opposed by 43%, 32% is mixed, and only 25% is in favor of increasing taxes (LLP, 2009). So this is a bit disheartening because most people are not willing to part with their money, even if it will be saving us money in the long run. According to USA TODAY the National spending grew a projected 7.8% in 2003, down from 9.3% in 2002. The country spent on the average of $5,805 per person in 2003. This amount is much higher than the per capita amount spent in other industrialized nations. (Appleby, 2004 )The consumers job is to very boldly announce their expectations of the HMO’s and if their needs are not being met to voice their opinions and demand change.

What ways can we improve the communication between HMO’s and the people buying their coverage? Laws could be passed by Congress that force the HMO’s to take more public surveys to get input from the public so their plans of coverage are the most cost efficient and the highest quality. On the other side of that coin is educating the public of heath care coverage. It is so easy to throw in your disappointments with a program and how it’s not helping you but if all you are doing is complaining then really what right do you have? You are not bettering yourself or others if you just get on your soap box and complain. Action is key, lobbying for changes and advocating are positive ways to get the same disappointments across but in a productive way.

By taking these steps to better both sides hopefully the access, quality, cost, and overall communication will improve. Being optimistic is a huge advantage because it’s not being oblivious to problems, but by having a different attitude much more is accomplished. “The United States spends at least 40% more per capita on health care than any other industrialized country with universal health care” (John R. Battista, 1999). Even though this talk occurred in 1999, the argument still stands strong we are paying too much money and there are too many people uninsured in the United States. When are we going to get off our high horse and look at other nations who are thriving because of Universal Health Care? It is about time we step up our game and help the 46 million people who are uninsured. (WOODRUFF, 2009) By picking apart HMOs’ we can reduce the cost, increase access, and also quality because we will know what the consumers need.


Works Cited
Appleby, J. (2004 , Febuary 12). Almost $1.7 trillion spent on health care in '03. Retrieved March 30, 2009, from USA TODAY: http://www.usatoday.com/money/industries/health/2004-02-12-healthcosts_x.htm

Chippewa County-Montevideo Hospital and Medical Clinic . (n.d.). Retrieved March 27, 2009, from Health Care Terms: http://www.montevideomedical.com/Pages/Page_05.htm

Daniels, N. (1998). The Ethics Of Accountability In Managed Care Reform. Retrieved March 27, 2009, from Health Affairs: content.healthaffairs.org/cgi/reprint/17/5/50.pdf

John R. Battista, M. a. (1999, June 4th). The Case For Single Payer, Universal Health Care For The United States. Retrieved March 30, 2009, from Connecticut Coalition for Universal Health Care : http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm

LLP, D. (2009, March 16). Health Care and Public Policy: What Do Americans Really Want? Retrieved March 27, 2009, from Deloitte.: http://www.deloitte.com/dtt/article/0,1002,sid%253D80772%2526cid%253D242408,00.html

WOODRUFF, J. (2009, Febuary 11). The Uninsured in America. Retrieved March 30, 2009, from The Online News Hour: http://www.pbs.org/newshour/indepth_coverage/health/uninsured/

Reform Proposal 2

The United States spends more on health care than any other nations, yet, in 2004, 41.6 million Americans under the age of 65 were uninsured. This accounted for about 16-17 percent of the total population. (Shi & Singh) “In 2008 health care spending in the United States reached $2.4 trillion”. (National Coalition on Health Care) These numbers represent a system that is far from the ideal health care system. Too many people are living without health insurance, and many of those with health insurance are paying too much while the quality of care remains unbalanced. It is unlikely that many would argue with the fact that change is needed, however, few would agree on how to go about doing this. Our group agrees with the Obama-Biden team and feels that in order to head toward a change that is positive, we must look at current systems and work on improving on them. An example of one of these systems is Managed Care Organizations (MCOs).

Some may disagree with the idea that MCOs should be the focus of a health care reform, stating it is just a small part of the system and it doesn’t even cover all Americans. However, MCOs are a large and vital part of our current health care system and could have a direct or indirect impact on many different areas of the health care; including inpatient, long-term care, finance and special populations making it a crucial part of the health care system. MCOs emphasize primary care, which is a great way to save the health care system money. MCOs also offer health care to a variety of people and works to keep costs down using a prepaid system. One of these systems is Health Maintenance Organizations (HMOs). Like the Obama-Biden team we believe Managed Care Systems such as HMOs are beneficial to our health care system and using the HMO model to move toward a health care system that is universal is an important step in improving our health care system. However, before this can occur, changes to the current system need to be made.

Change can begin with the restructuring MCOs. This would be done by creating a well organized information system that remains consistent across the nation, with minor changes from state to state. We feel it is important for these systems to remain consistent, but understand that different areas consist of populations that differ in their needs and should have a health care system that best fits their specific needs. We believe there should be a push for an upgrade and integration of information to be part of the integrated delivery network. We also believe these systems should be fair so, reasonable prices should be set and standardized for all procedures making it affordable to all. These standard prices would then be enforced through the MCOs. This standardization would put an end to unnecessary high costs and allow the focus to be put on improving the quality of care.

We feel that if these changes are made to MCOs, the nation would benefit greatly. People would be more likely to focus on preventative care, allowing them to be healthier, stronger and more productive; which is a great benefit to the economy and saves the health care system money. We would have less uninsured Americans skipping out on regular checkups and avoiding hospital visits which often end up costing more in the long run and remain unpaid by the patient, leaving the burden on others. Standardizing prices would also promote competition, causing more of the patients to base their health care decisions on quality instead of price, which would in turn push physicians and hospital to strive for better quality of care.

By Becky Zay

Health Care. Retrieved March 1, 2000 from http://www.whitehouse.gov/agenda/health_care/

Kongstvedt, Peter (2008). Managed Care: What it is and How it Works. Sudbury, MA: Jones and Bartletts. (2008/12/9). Managed Care. Retrieved February 27, 2009, from MedlinePlus Web site: http://www.nlm.nih.gov/medlineplus/managedcare.html

National Coalition on Health Care. (2009). Health Insurance Cost. Retrieved February 26,2009, from http://www.nchc.org/facts/cost.shtml

Shi, L, & Singh, D (2008). Delivering Health Care in America: A Systems Approach.Sudbury: Jones and Bartlett Publishers.