The managed health care is perhaps the leading form of healthcare carried out globally especially in developed nations such as the US. The managed care is a system that provides health care to a particular population that is bought through the health insurance plan. The practitioners and providers manage the use of health care services and cost by offering effective diagnosis and treatment. For example, the health service delivery in Saudi Arabia whether private or public is under the proposed national health insurance (NHI). However, it should be through a managed care model (Kongstvedt, 2012). This is because the managed care programs have proven effective in reducing unnecessary inpatient and ancillary service usability, getting rid of expensive procedures. Therefore, the paper will analyze the need for a managed care in Saudi Arabia.
The Benefits of Managed Care
The first and main advantage of the managed health care is the aspect of lower costs connected with them. The primary aim of the managed care is to keep the cost of health care as low as possible without compromising the quality of care that is given. This is done by building a network of providers that can provide care and referrals in case of any health need which needs to be addressed. Another advantage is that people are able to seek care from within their network. Based on this, the referrals are made fast when the services or procedures are required to be completed through a network provider. For example, an individual is able to visit their primary care provider one day, acquire a referral to a specialist and further make an appointment the following day. The rate through which the managed care can give a result is fast when properly managed by the patients. Moreover, the managed care keeps the families together. In order to manage health care, a development of a relationship between patients and provider. In absence of these relationships, the care providers and doctors don’t have all the information that may be appropriate to make an accurate diagnosis (Berenson & Rich, 2010).
Disadvantages of Managed care
The other side of the coin in managed care for some people is the rigidity of the rules based on the choice of healthcare providers which is true for HMOs. In most cases, a member may not be fully satisfied with the care that is offered by the primary care physician and would require making a consultation with one another. Moreover, it limits care access for people who don’t have insurance coverage. If an individual is poor and living in a system with managed care, then the options are scarce.
Healthcare industries most affected by managed care
The managed care affects various healthcare industries. The managed care has emerged as the dominant technique of health care providers in the many nations. Therefore, with the introduction of the managed care system in the healthcare, there are various industries that tend to provide an alternative program. The Health Maintenance Organizations (HMOs) and also Proffered Provider organizations (PPOs) provides the kinds of managed care health insurance plan. The healthcare consultation departments, a traditional fee for service health insurance plan and also upcoming health care providers are affected by the managed care. For example, the national insurance of Saudi Arabia will be affected by the managed plan (Halpern & Pastores, 2010).
Impact of managed healthcare on patients, physicians, and facilities
With the managed healthcare system, the patients are able to get quality services at affordable cost. The enrollees are able to use the method of capitation for making the payment which means that they are able to pay a pre-determined fixed fee monthly for the duration of one to three years irrespective of the number of times they use and how much it cost each time. More benefits are patients receiving preventive care, fewer unnecessary preventions, lower premiums and low costs of prescription.
These are the personnel who provide health care services to the patients. The rise of the managed care has been faced with much trepidation by physicians with most of them fear that it will reduce their income and autonomy. They provide some of the reduced fees because of the high volumes of patients to balance up for a discounted price. For example, the participation of the managed care also influences the physician’s assessment of their clinical decisions making. Moreover, the physicians who participate mostly in managed care always report less control over their work schedule and also a less satisfaction with what they receive as payment. There is always an agreement for participation in the plan.
The managed cares don’t have health provision facilities but they use the existing facilities within the society to assign the physicians to a specified doctor. The managed care plans limit the selection of physicians and healthcare facilities and control all the usability of services and the rate charged for the operations (Kongstvedt, 2012). The primary types of HMOs are the group or staff model. Therefore, in regards to the group model the plan’s physician share facilities and equipment. Some of them are hired by HMOs while others are compensated in various ways like a capitated rate per individual. Consequently, the facility for both accounting and record keeping is greatly affected by the managed healthcare system. The enrollee is expected to make a notice to be served to the care department for an immediate allocation. Therefore, a more fast and large in terms of storage will be needed to operate the services.
How managed care is working for other countries
Many nations globally are importing the managed care system from the United States of America to improve the achievement of their health care system. It is part of the American health care system and has become the name for a transformation in the way is financed and coordinated in the US. For example, a person living in the US and have acquired a health insurance, there is at least a75% capability that he or she is part of a managed care group. However, even with the vocal backlash by consumers, the enrollees’ satisfaction with managed care tends to be high. A survey of more than 3000 Medicare patients found out that about 87% of the HMO for a standard care. Therefore, it is imperative that the managed care is working well for the many nations across the globe such as in California, Africa, and other nations. In these nations such as California, almost half of the populations are using the managed care system for their medical services. The traditional payment system was replaced by the managed care system for provision. It will be important for Saudi Arabia to improvise the use of managed care for the citizens to get quality and affordable health care.
Berenson, R. A., & Rich, E. C. (2010). US approaches to physician payment: the deconstruction of primary care. Journal of general internal medicine, 25(6), 613-618.
Halpern, N. A., & Pastores, S. M. (2010). Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Critical care medicine, 38(1), 65-71.
Kongstvedt, P. R. (2012). Essentials of managed health care. Jones & Bartlett Publishers.
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