The managed care approach adopts a consumer-driven method to provide healthcare services. Some people feel that this consumer-driven approach may be just a small modification of the regular practice system, rather than a revolutionary method. People feel that if patients are given too much control over how much they spent, soon customers would be asking the service providers to reduce costs further, which may have a negative effect over the quality. Several other healthcare schemes also exist such as the HRA and health-savings accounts (HAS) that would help the patient’s to save taxes, and thus compete with managed care.
Over the years, the healthcare care system in the US is being sponsored by third-parties and the corporate sector. People feel that reduced government control and greater private funding would result in increase of the costs of the services and reduced control over costs. However, a consumer-driven approach, provides greater control to the clients and less control by other parties, although, they may provide a certain proportion of funds. The consumers should feel a certain amount of value for the services being provided.
A consumer-driven approach needs to balance itself between direct payment and insurance coverage. Insurance may seem to be a bit of an administrative problem. HRA and HSA tries to find an effective balance between insurance and direct payment. The balance may vary and depend on several factors such as age, location, utilization extent, socio-economic status, health status, etc. The patients should be able to make decisions over quality and the cost of services. In managed care, the customers have limited access to information, whereas in HRA people usually seek alternatives, frequently.
People look beyond cards and fact sheet provided by the company about information of quality and cost of the services. Some people may even initiate chat conversations and blogs on the internet. Some people even suggest of the post-payment or installment schemes to pay for healthcare services. Insurance and managed care does not seem the only manner in which healthcare services are to be compensated. Many physicians feel that the cost of maintaining and developing a payment networking system is itself very costly.
Some physicians have even started a ‘cash-only payment’ system, by which they can substantially reduce the over-head costs. Some physicians, who accept insurance packages, may be charging a little extra from willing patients in an effort to improve the quality of services. Managed care relies on several non-medical professionals who aid the physician in providing care. This kind of an approach has helped to keep the cost more under the consumer’s control. HMO’s usually provide basic care, and specialize only in a few fields such as cardiac care, surgery, gynecology, etc.
Specialization offered in other fields is very limited. Medical tourism are also being offered to by several organizations by which US citizens are allowed to travel to certain developing countries in order to get certain treatment done at a fraction of the cost. Several people also began to the question the manner in which HMO’s are able to reduce cost through several measures employed such as lowering-costs, selecting healthier customers, improving efficiency and effectiveness, refusing services, reducing payments to the staff, or by other methods.
The American society tends to thoroughly reject goods and services when they do not seem to fulfill their needs. Hence, a customer-driven approach is vital for any system to survive in the US. The consumer will look in to several factors such as cost-effectiveness, general trends, responsiveness of the system, user-friendly approach, convenience, etc, before selecting the system. These factors will definitely affect the policy adopted by the healthcare system to deliver services.
References: Firshein, J. and Sandy, L. G. (2000). The Changing Approach to Managed Care. In Isaacs, S. L. and Knickman, J. R. (Ed). To Improve Health and Healthcare. http://www.rwjf.org