Managed Care Essay Example | Topics and Well Written Essays - 1500 words

Managed Care - Essay Example Reference is made to the context and the forms of managed care, as described through the literature and the relevant empirical research. Furthermore, the critical examination of the current activities of managers in health care organizations has led to the assumption that these activities can be influenced by the policies related to managed care but the power of these policies to introduce radical changes in these activities is not standardized, being related to the conditions in the internal and external organizational environment and the personal perceptions/ background of the individuals (managers) involved. In order to identify the potential influence of managed care policies on the activities of managers in health care organizations, it would be necessary to refer primarily to the elements of the managed care framework, as it has been extensively developed across USA. Different approaches have been used in order to describe managed care, probably because of the extension of the particular framework. In accordance with Rickel and Wise (2000) managed care can be described as a framework ‘establishing networks of service providers who agree to the conditions of a contract and choose providers based on the cost, quality and range of services they provide’ (Rickel and Wise 53). ... work is described in the study of Edmunds (1997); in accordance with the above study, managed care ‘imposes limitation on utilization of health care services by specifying which practitioners and which services are covered – often, also the number of allowable visits’ (Edmunds 41). In other words, managed care involves in the critical examination of a case (referring to the patient visiting a health services organization) and the referral of the case to appropriate specialists who have the skills and the experience to handle it. Of course, there are chances that the health problem of a patient can be effectively addressed at the first level of the network – i.e. by the primary care provider. Through the above process, the costs related to the health care services are reduced, in the terms that unnecessary expenses on health are avoided, a fact that can significantly benefit the patients but also the state – in cases where medical expenses are covered by the state. From another point of view, the time and the resources spent on each case are appropriately filtered, increasing the effectiveness of health care organizations, which, through the managed care plans can handle more cases, i.e. they are able to respond to the needs of more patients, a fact that increases the effectiveness of the entire health care system. In order to understand the potential influence of the policies of managed care plans on the activities of managers in health care services organizations (HSO), it would be necessary to describe the environment in which these plans are developed; it would be also necessary to refer to the participants, at the level that their decisions and initiatives could affect the activities of managers in HSOs. In accordance with McKenzie and Pinger (2008) the