Follows all Project assignment details and technical requirements, presenting "a managed care-related topic, thoroughly explaining what it is, why it's important, and how it fundamentally impacts the managed care system today."

Presents an argumentative paper with reasoning and evidence of debatable issue.

1. Incorporates key elements of a quality research paper:

Strong thesis statement that states the main point of your project and suggests the path that your project will follow.

Attention-getting introduction moving into quick transition that leads into thesis. Captures readers' attention.

Topic sentences relate back to thesis statement. All information is relevant to thesis.

Logical transitions between paragraphs and ideas provide unity and coherence to the whole. Clear organization.

Concluding paragraph sums up information and reiterates thesis.

Mechanics follow required standards. (Spelling, grammar, sentences written according to Standard English.)

Technical RequirementsAn original research paper with a body of 6-8 pages. In general, your paper should consist of the following pages:Title Page - captivating title, your name, title of the course, dateBody - 6-8 pages of introduction, background on your topic, research support, personal evaluation, strong conclusion. Body should be organized with a minimum of the following titles

 

Introduction

            The beginning of the managed care revolution in the 1990s was interpreted as a step towards success in healthcare delivery. The objective was to stabilize health insurance premiums and the overall national costs of healthcare as a percentage of the GDP. This seemed like an attractive package and policy amendment, which has led to the adoption of managed care as the dominant method of healthcare provision over the years. Two decades later, the expected success of the managed care models seems to have been a temporary event. This is evident from the emerging debates on the effectiveness of the managed care models in healthcare financing. On one side, there is a tremendous outpouring of anger, resentment, hostility, and frustration from providers and patients on managed care. On the other side, there are still stakeholders who view this as the leeway to accessing quality healthcare and reducing the cost of healthcare in the United States. This paper explores the impacts of managed care models of healthcare financing on the quality of services extended to the patients. The hypothesis and position are that managed care has adverse effects on the quality of healthcare. The paper will adopt an aggressive approach analyzing both the reasons for the hypothesis and against the hypothesis.

Relevance of the Topic

            Before delving into the reasons for this argument, it is integral to understand how a managed care model of healthcare financing operates. Managed care is a health care delivery model developed and implemented in the U.S in the 1990s to help reduce healthcare costs while still seeking to improve the quality of services provided (Goujon & Emiliano, 2021). The model uses a network of providers who support the wellness needs of a patient. The managed care agencies will usually select a network of providers and primary care physicians responsible for the patients. They then create contracts with them to ensure that the patients receive coverage of their medical services and prescription drugs. The three forms of managed care scenarios include health maintenance organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Sale Care (POS).

Managed care aims to have patients with multiple options for coverage while still paying lower costs for their prescription medications (Montoya et al., 2020). The issue of quality is an essential topic in managed care since there is a need to administer designs, systems processes, and policies that will minimize harm when extending healthcare services to patients. Managed care systems would be useless if healthcare quality is poor since patients would continue going back to the healthcare providers. Poor quality when using managed care may also endanger the patient's long-term healthcare outcomes, hence the necessity of this topic.

Reasons

            How do managed care models have adverse consequences on the quality of healthcare services extended to the patients? Heath.gov (n.d) defines quality healthcare as 'healthcare that is safe, effective, patient centered, timely, efficient and equitable.' This was the expectation after the introduction of the managed care models. However, the implementation of this model was far from the expectation. The largest employers in the nation offered multiple-choice plans for their employees. These employers are the fewest in the nations, which means that most did not offer multiple-choice plans. Instead, they looked towards the model of outsourcing health benefits to one carrier to reduce administrative costs.

The carriers, in turn, promised the companies to lower premiums, albeit in the short term. This led to pressure on the managed care organizations to involve all doctors in the state networks regardless of their status as 'good' or 'bad doctors.' The goal was to blindside the employees to appear to be visiting their providers of choice after all. This strategy resulted in the acceptance of poor and good quality doctors in the managed care system, which undoubtingly leads to the provision of poor health services from some practitioners. Additionally, the merger between poor quality and good quality practitioners inhibited forming cohesive groups of providers who would work towards continuous quality improvement (Deom et al., 2010). This has constantly prevented the improvement of the quality of care in the healthcare arena despite the changing needs of the patient population.

            The patient-physician relationship is an integral marker for the quality of care that will be extended to the patient. The managed care model is aimed at the reduction of healthcare costs. Any financing model that aims at the reduction of costs increases the pressure on productivity. As such, physicians have more pressure to do more, which leads to spending less time with the patients. The lack of an appropriate amount of time with the patients is detrimental to the patient-physician relationship. When the physician spends less time on the patients, they are less likely to involve them deeply in decision making or extend the appropriate amount of care. This leads to deterioration of the quality of care (Hines et al., 2017). For instance, the physician does not have the time to involve the patient to make decisions together. This means that they will often look at the patient's problem on the surface and may even miss important aspects such as environmental influences on health, reducing the quality of care extended.

            Notably, the rules of managed care are quite rigid, which affects the quality of care provided. Managed care systems limit the options of selecting an individual's doctor. This leads people who cannot afford an out-of-network doctor to stick to the services they are receiving even when they are not adequate. This then affects the quality of care delivered as often patients may require second opinions from providers not within their network (Deom et al., 2010). For the patients who can afford to seek an out-of-service provider, the insurance may fail to cover that expense if they do not advocate for themselves. This then brings in the other aspect of the cumbersome nature of the patient advocating for themselves. The patient may need to advocate for their healthcare if they need care from out-of-network services. While patients may look into it, some will give up, affecting the quality of healthcare they receive and health outcomes. 

            The quality of care should be effective and safe. This means that physicians are responsible for ensuring that they order the necessary tests for their patients and do not go against ethical principles by undertreating the patients with malicious intent (Lyu et al., 2017). Overtreatment and undertreatment are problems identified in the healthcare systems of the United States with managed care financing models. There have been constant complaints within the managed care network involving offers of unreasonable services by medical providers. Patients indicate that the doctors may order needless tests to maximize the billings submitted to the insurance companies. Although this is poor ethics on the side of the practitioners, it is not a deniable action. It equates to the overtreatment of a patient (Lyu et al., 2017).

On the other hand, there have also been patient complaints of doctors refusing to order necessary tests to avoid referring them to out-of-network service providers. This is referred to as the under-treatment of a patient. There are varying reasons why physicians may engage in such unethical practices. The physician may want to keep the reimbursement within their facility and avoid referring to other healthcare facilities. This affects the quality of care given that some patients may be in dire need of accessing healthcare facilities for out-of-network service providers.

            The extension of quality healthcare should be equitable, meaning that even the poor and uninsured should have a place within the model. This is what would guarantee the provision of quality healthcare across all populations irrespective of their diversity. However, the managed care model has little to say about the poor and the uninsured (Maniam, 2018). If people are poor and living within a managed care model society, they have limited options in seeking access to healthcare. The option is for the individuals to get access to care in the emergency room if their healthcare problems equate to emergencies. They cannot access providers in private care as they are unable to pay for their healthcare services. This is detrimental when it comes to focusing on the provision of quality care equitably.

Further, some patients enrolled in managed care plans may also be left out to provide quality care, especially if purchasers do not represent their needs. These include people who may have complex healthcare needs putting the patients at a risk of entering healthcare provider networks that may not be able to take care of their often complex needs (Montoya et al., 2020). This inhibits the quality of care that they receive from the healthcare facilities. Under different care models, the individuals would have access to quality services from providers that understand and handle their complex healthcare needs.

Objections

            The proponents of managed care models argue that it has helped advance the quality of care for the general population. One of the arguments is that there is a certain guarantee of care within a particular network. The managed care networks have put in place strategies that will ensure all the care network members have some basic accreditation. This helps in the provision of patient care as effectively as possible. The argument is that there can never be a risk to the quality of healthcare services extended since qualified practitioners are taking on the job. The other objection is that physicians behave and are guided by ethical principles while administering services (McKoy et al., 2015). There are low risks of having overtreatment and under-treatment issues as a hindrance to extending quality healthcare services.

Further, the reimbursement models utilized by providers take into account any adverse events caused to the patients. Purchasers under the managed care models could refuse to reimburse healthcare facilities for medical errors or negligence cases. Hence, practitioners do not intentionally undertreat individuals as it could lead to the loss of reimbursement in the end (Andel et al., 2012). The proponents of the managed care model may also argue that the wide-reaching network of practitioners would never allow an opportunity for reduced quality of service provision. There are different physicians and healthcare providers at each level of treatment. This means that the quality of care, according to the proponents, is top-notch given the diversity of services available for patients.

Support of Responses

            The first objection revolves around accreditation as a way to ensure a guarantee of the quality of care. While accreditation is an important element in ensuring that physicians gain access to patients and extend care, managed care models still have a gap. Sometimes, there is the push to hire younger and more inexperienced providers to save cots. Although there is still an accreditation mandate, the inexperience may affect the quality of healthcare services extended, meaning that accreditation does not guarantee the quality of healthcare services in the managed care model.

The argument on ethical practices of practitioners as a way to reduce any malpractice is quite weak. Physicians are faced with different situations every day in their lines of service, which require them to follow medical ethical principles (McKoy et al., 2015). However, these guidelines do not stop the practitioners at any given time from engaging in malpractice, depending on their personality traits. This, coupled with the managed care model, pressures practitioners to increase productivity, accelerates the possibility of having the practitioner undertreat or over-treat the patient and thus lower the quality of healthcare services. This claim is refutable on the availability of diverse service providers within the network by looking at people's lens that may require out-of-network service providers. These individuals may have to pay for the needs of the out-of-service network providers or continue to gain their healthcare services from the in-service team, which may not be meeting their needs at that particular time (Maniam, 2018). This is undoubtingly going to result in negative patient outcomes.

Conclusion

Admittedly, the managed care models intended to reduce costs while not compromising the quality of healthcare extended to the population in the U.S. In the initial years, the care model achieved this element through the reduction of healthcare costs. However, the quality remained an elusive goal due to various factors among the stakeholders in providing healthcare services. The need to reduce costs overtook extending quality healthcare services to all regardless of their diversity. Today, the model treats patients as more of products than people, meaning that the deterioration of healthcare services has been quite evident over the years. As such, healthcare policymakers need to address the limitations of managed care that threaten the quality of healthcare services to ensure positive population health outcomes. The policymakers should take the needs of diverse citizens into account before settling on healthcare financing models.

Outline: Managed Care

• Introduction

The beginning of the managed care revolution in the 1990s was interpreted ass a step in the right direction by most people.

• Relevance of the Topic

Before delving into the reasons for this argument brought forth, it is integral to understand how a managed care model of healthcare financing operates.

• Reasons

How do managed care models have adverse consequences on the quality of healthcare services extended to the patients?

• Objections

The proponents of managed care models argue that it has helped to advance the quality of care for the general population.

• Support of Responses

The first objection revolves around accreditation as a way to ensure guarantee of the quality of care.

• Conclusion

Admittedly, the intention of the managed care models was to reduce costs while not compromising on the quality of healthcare extended to the population in the U.S.