Evolution of Managed Care in the United States Essay

Health care system in the United States has experienced different times of both advanced progress and continuous failing; on the whole, it represents such a great structure that it is just impossible to manage by state only or by means of private organizations as well. In this or that way, health care system, together with legal and tax systems, belong to those fields where there is an undisputable need for an agent. The question is how to make this agent work properly for the sake of the recipient of service and whether it is possible at all.
In fact, at the dawn of its development managed care was an attempt to represent such kind of a reliable agent, a mediator between a patient and health care services providers. The first official affirmation of such a body took place during the rule of President Richard Nixon who is considered to be the first political leader to make crucial changes into health care system of the United States. Thus, in 1973 his administration passed the famous Health Maintenance Organization Act. The aim of the document was to make a shift in relationship between patients and doctors and to direct health care into more profitable course. Specifically, the Act encouraged the advancement of Health Maintenance Organizations which can be seen as a prototype of modern managed care facilities intended not only to treat, but rather maintain their clients’ health and thus were oriented to preventive measures. These organizations had their own facilities and hired professionals. They played their significant role as they really helped to reduce the expenditures during the inflation of 1980s. The result was achieved by cutting down needless facilities, by stimulating the providers for discount systems, and by strengthening public control. In this way health care industry was becoming more efficient, accountable and competitive (Tietze & Sinha, 2003). In theory, this system provided patients and physicians with wider opportunities of choice; some services could be rejected, others reviewed. Sometimes stay was not needed as long as prescribed, or contracting with different health care providers was rational.
Gradually, health care was becoming more and more private, but credit was not to be everlasting. Practice has shown that managed care organizations (MCOs) often failed in their cost controlling mission; quality of services was doubted too. Now there is still much dispute on the role and effectiveness of managed care in the United States. At the beginning of the 21st century a large part of American population has shown that they have lack of trust to MCOs. Popular opinion was that these organizations are rather collecting their money than caring of their health. Time spent with patients was cut; specialists have become less available; and, what is more, savings were not so clear (Ferris et al., 2001). Besides, it was traced that sometimes cost savings were reached at the expense of denying necessary treatment in life-threatening circumstances or just decreasing the quality of care. At the turn of the century expenditures on health care went on outstripping the overall national income.
However, the net of managed care organizations is covering the states rather tightly, being almost ubiquitous, from the north to the south and from the east to the west. Integrated delivery systems include a number of specific providers who are selected for giving services by some definite standards. There is a set of financial incentives that encourage the enrollees to be active customers. Currently, many managed care mechanisms do not include a provider network and are called “managed indemnities” (Emanuel & Fuchs, 2008). What’s more, there is another bright tendency: some facilities are trying to concentrate on some specific field like oncology or gastroenterology. They do make profit, but they are criticized for just “skimming the cream”, as they hardly can concentrate on those specialties that do not make profit like traumatology or emergency. Other organizations prefer to act without dealing with employers and independently of the health plan.
Nevertheless, the health care system of the United States is typically in crisis and needs much reformation. The administration of Barack Obama is now pushing Clinical Care reforms that make an emphasis on prevention, deal with payment systems, and are intended to increase the accountability and transparency of health care facilities and all the parties involved to keep a healthier balance between costs and outcomes. More than ever, stress is made on information services. It is said that the society has a need for the managed care organizations to be substituted by something like value care organizations. Reform initiatives of the last couple of years are directed to create a model in which “the HMO can develop and disseminate guidelines on cost-effective care, while the enrollee’s primary care doctor can act as patient advocate and care coordinator, helping the patient negotiate the complex health care system” (Karpf et al., 2009). According to the government reports, they are now expecting to create a “far more efficient, convenient, responsive, and affordable” system working for the consumer (Scandlen, 2005). To enhance the evolution, there are initiatives on encouraging the competition between the service providers and special MCO agents.