Health insurance and managed care have changed significantly over the past 50 years. Discuss reasons why these changes were made. Discuss why these changes have not been able to curb the high costs of healthcare. Summarize the ethical and legal issues involved when an insurance/managed care company denies coverage to a patient with medical necessity.

  As Showalter (2017) describes the definition of management care plans is very extensive. Managed care plans are insurance programs designed by a range of mechanisms to reduce unnecessary health care costs, including:

Cost-sharing programs for medical needs for specific services, increased recipient cost shares, stay and hospice controls, the establishment of cost-sharing incentives for ambulatory operation, selective contracting with healthcare providers, and intense management of high-co-operation services for doctors and patients to choose cheaper types of care. Programme, for example, health support agencies and favored provider organizations, are provided in a variety of settings."

  Health insurance and managed care in the last 50 years have changed significantly, mainly because of the rising costs of health care. As costs began to increase in the 1980s, managed care plans were adopted by employers for cost-reduction purposes. This led to a growing number of employers in the controlled care industry.

Step-by-step explanation

The managed care has undergone certain changes since the 80s, according to the Institute of Medicine (1997:

• "First of all, the management of access to health care, mainly through use reviews and administrative barriers, such as the certification before acceptance.
• The following phase focuses on management benefits, and additional fee-for-service provider networks, selective contracting and treatment planning.
• The third phase focuses on the management of care, with a change from the use review to the management of use and an emphasis on the adequacy of care.
• The fourth phase, which started in recent years, consists of managing outcomes in a complete treatment service system." It was mainly due to excessive administrative costs for managed carers that these changes were unable to curb the high health costs.

   There are no regulations on the industry for another reason. They look like they run a muck. If an insurance or managed care firm refuses to cover a medically needed patient, they do so for only one reason - profit. They put the health and well-being of patients behind the desire of the firm to make the maximum money. Patient care is refused if it is regarded as excessively expensive by some arbitrary person at a desk who seeks only to save a dollar to avoid paying for more expensive services.

   Managed care ethical issues While 'managed care' refers to a rather heterogeneous group of institutions, a common feature of all MCOs is a systemic approach to controlling what had been a sharp increase in health care costs in the country.
An insurance undertaking, agent or guarantor can remain strictly in accordance with written law but still be unethical. Some of the ethical challenges insurers face are universal: in all profession, for example, discrimination against minorities is wrong. Other problems distinguish the world of insurance.