Health Prevention Initiatives and Cost Containment Term Paper

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¶ … managed health care and evaluates their validity and success rate. The writer explores cost containment, health prevention, health population focus and other elements of managed health care to determine their probable success or failure. There were four sources used to complete this paper.

Managed Health Care Revisited

As America's health care costs continue to skyrocket and the public demands changes managed health care has continued to expand its services nationwide. Whereas years ago managed health care was a rarity in the health care and insurance industry, it is now moving toward becoming the most commonly system used for health care delivery. Several decades ago, managed health care was the brunt of many problems. Those who were using it through their insurance plan believed that they were getting substandard care and there were many complaints lodged about having to wait months for appointments and once the patient was at the doctor he or she failed to order appropriate tests to determine the cause of the patient's symptoms.

As time moved forward however, insurance companies began to depend more on managed care providers and with those changes came improvements in the system. Currently managed health care offers a wide variety of health care needs and provides tests, diagnostic and curative measures to their patients, but one of the most significant things that managed health care offers is preventative maintenance. The field of managed health care is a numbers game. The system is counting on more people paying premiums and not needing to be treated for anything than patients who have medical issues to be dealt with. One of the things that managed care organizations do to prevent the rising cost of medical care is provide solid and consistent preventative care options to encourage patients to get check ups and work to treat any problems that arise while they are still at their beginning stages.

Today, managed health care has come through many years of attacks and scrutiny only to come out stronger than ever before. Using quality improvement measures, health care prevention alternatives, cost containment strategies and other elements, managed health care is providing consistent, quality health care to individuals while working to harness the runaway costs the nation is currently experiencing.

Health Prevention Methods

One of the most important elements of a managed health care program is to promote and utilize health prevention programs and alternatives (Jacobson, 1995). With health prevention initiatives the patients are encouraged to come in to see a doctor at the first sign of trouble.

At first glance it appears that this would be a money wasting proposition but when one takes a closer look at the system and the cost factor of health prevention initiative one will see it actually helps the managed care organization save money, which in turn can be passed onto the consumer in the way of lower premiums (Jacobson, 1995).

One recent study was used to examine the cost factor when it came to diabetic patients. The study explored whether preventative care measures were able to reduce the health care costs of patients with diabetes or if they remained the same (Jacobson, 1995).

The patients who came in for regular checkups and called doctors at the first sign of a problem cost the managed health care system less money than those who waited until there were significant health issues before seeing their physician.

When a consumer has symptoms that could be cancer, or some other serious disease, but could also be something minor that does not require treatment they often wait to see a doctor to see if it goes away on its own (Jacobson, 1995).

This can lead to waiting until the cancer or other disease has done significant damage and will now be an extremely costly illness to deal with.

Managed care organizations have studied this pattern and have realized that the best way to lower the cost of health care is to actually encourage the consumer to utilize preventative care options as often as needed.

This can include regular check ups, minor procedures that could have waited to see if the condition worsened but it would have cost a lot more had they waited, education programs to encourage and promote self health awareness, and the provision of diet and nutrition classes, aerobic and fitness classes, and stress reduction courses that can all play a part in reducing health problems (Jacobson, 1995).

They work by encouraging consumers with many low cost or free options when it comes to preventative health care. In return for providing these low cost and free options the managed health care organization saves money by preventing more expensive problems that could have cropped up had the self-help and early diagnosis issues not been addressed.

Cost Containment Strategies

In addition to preventative care measures, many managed care organizations have turned to cost containment strategies as well in the effort to reduce costs which can be passed onto the consumer by way of lowered premiums.

Healthcare is distributed on a group basis to 161 million Americans below age 65 and converting to an individual market orientation would take years. Moreover, the health system is often too complicated for the average person to navigate (Exton, 2002)."

One popular cost containment strategy is to provide medical spending accounts in which the consumer has a named dollar amount in holding and can spend it on whatever healthcare options he or she wishes to use it for. This way the consumer with concerns about weight can use it to learn about nutrition and diet, while the slim consumer with a heart murmur might use his or her funds for a cardiologist referral.

Some cost containment plans call for the consumer to reap a financial reward based on how much is left each year or how many preventative options they used to help keep the long-term cost of their health care down (Exton, 2002).

A new study indicates that managed care plans are being increasingly used by employers to help contain workers compensation claims. Another study done in 1992-1993 by the Workers Compensation Research Institute finds that 37 out of 50 states and District of Columbia have added strategies to control costs through legislation. Cost containment of workers compensation medical costs is one major reason for the drop in the industry's combined ratio (Fletcher,1995)."

Some states have implemented treatment schedules while others have implemented care plan schedules and still others have implemented other initiatives to keep the cost down.

Such measures work because they allow a more accurate ability to forecast budget needs with regard to supplies, staff, overhead and other elements of health care organizational structure.

Quality Improvement

Many managed care organizations now use performance measures to provide quality improvement.

All managed care organizations interviewed use performance measures for quality improvement but the degree and sophistication of use varies. Many of our respondent plans use performance measures to target quality-improvement initiatives, evaluate current performance, establish goals for quality improvement, identify the root cause of problems, and monitor performance (Doty, 2004)."

While there have been few studies on the use of cost containment strategies in the world of managed health care those that have been conducted show that the measures are important foundations to improve the quality of the health care being delivered.

Finally, a study by Hillman and Goldfarb (1995) examined the quality-improvement programs of six HMOs selected from a list of 31 HMOs deemed exemplary by a panel of experts (Doty, 2004). The authors conducted site visits in 1992 to identify characteristics that made these quality-improvement programs exemplary (Doty, 2004). Although their study predated the widespread adoption of HEDIS and other standardized performance measurement systems, the authors found that the six organizations were significantly ahead of other plans in terms of collecting data that are useful for quality-improvement programs… [end of preview; READ MORE]

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