Chapter one that covers on “A history of managed healthcare and healthcare insurance in the United States” provides a summary of the milestones United States’ healthcare system has made from the year 1910 upto the point where the Affordable Healthcare Act was enacted in 2010 and the successes witnessed thereafter as it describes this period as the period of healthcare insurance and healthcare management. This is to bring out the importance of providing healthcare to citizens through schemes such as healthcare insurance.
The early years of healthcare insurance and healthcare management are described to be periods between the years 1910 and 1940. Early forms of healthcare insurance that surfaced during this time are pointed out and the most notable ones include the Health Maintenance Organisation (HMO), the Blue Cross and the Blue Shield plans. The healthcare insurance models discussed in this period of American healthcare insurance and healthcare management history operated in two major ways. The first involved the beneficiaries of a healthcare scheme to pay on a periodical basis so as to get healthcare whereas the other involved a body contracting physician to provide healthcare for patients and covered even those who could not pay for their own healthcare costs.
The expansion of healthcare benefits in the United States between the years 19940 and 1960 where there was considerable growth in commercial health insurance in the United States. This is attributed to favourable taxation and laxity in wage control in the US in the aftermath of World War II. Plans that existed earlier such as the HMO grew during this glory stage and further new insurance plans came up such as the Group Health Cooperative of Puget Sound and the health Insurance Plan of Greater New York and this were not regulated for some time by way of statutory exemption so as to expand healthcare insurance schemes in the US.
Developments took place further in the history of American healthcare and some were facilitated by government interventions. Some of the inventions included deducting finances from taxes remitted to the government and also from the incomes of Americans in active employment. However, this did not cover all Americans and mostly unemployed young adults were left out. Regardless, these developments were taking America large strides towards improving their healthcare system. It also took government intervention to manage healthcare and health insurance in the United States and a key indication is the passing of the HMO Act by US Congress.
Development of managed healthcare moved from just management to consolidation. There was rapid rise in consolidated healthcare insurance providers across the United States in the latter stages of the twentieth century that securing healthcare insurance became much easy. However, there were sections of persons who felt they were being compelled to consolidated health care schemes due to the higher deductions if they opted for traditional healthcare insurance.
The first decade of the new millennium saw mixed fortunes in the economy of the US with a fast growing GDP and then the great recession afterwards, the cost of healthcare shot at a high rate and many Americans could not afford having health covers. Government took interventions for patient protection which prompted the passing of the Affordable Healthcare Act in 2010. The ACA of 2010 has impacted on the lives of Americans positively with the only challenge being healthcare costs and the desire for insurers to gain revenue from the schemes. A conclusion is made by applauding the role played by managed healthcare and restating that there is room for improvement.
Fox, P. D., & Kongstvedt, P. R. (2013). A history of managed health care and health insurance in the United States. Essentials of managed health care. Burlington, Sixth Edition: Jones & Bartlett Learning.