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Health Care Reform - Managed Care

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1. Perform a literature search on the current health care issue of Managed Care. Find an article and summarize the article (200 words).

2. Research a possible solution to the current health care economic issue of Managed Care. The solution does not need to be extensive, but must represent the solution identified in the research.

3. What are DRGs and what are their advantages and disadvantages?

4. What advantage would a physician have by accepting a capitation rate from a managed care plan? What would be the disadvantages?

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Solution Summary

Health care reform for managed care is summarized. What the DRGs and the advantages and disadvantages are determined.

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Health Care Reform - Managed Care

1. Perform a literature search on the current health care issue of Managed Care. Find an article and summarize the article (200 words).

Children's vulnerability as managed care enrollees

This article by Hughes and Luft (1998) focus on children's vulnerability as managed care enrollees. The authors bring attention to the fact that their needs for health services are significantly different from those of adults. Furthermore, as children grow and develop at rapid rates, this places them at special risk of the effects of illness and injury. As such, if health problems are not identified and treated, they can affect a child's cognitive, physical, behavioral, and/or emotional development.

Children cannot make their health care decisions on their own. As such, children are dependent on their adult caregivers for health service decisions; purchasing insurance coverage; and making judgments about the appropriateness of care services. To this end, the type, quality; quantity; and cost of health care are dependent on the ability of their adult caregivers to obtain appropriate services so they help children accordingly. According to Hughes and Luft (1998) research on managed care does suggest that it would help to contain costs and improve access to care. Because managed care could have some unintended consequences such as reducing access to needed care for certain high-risk populations, it may improve the quality of care for some, while making it worse for others (Hughes & Luft, 1998).

Overall, the basic impetus and tenet for the purpose of the article was to lay the foundational work for exploring what transitions in managed care could mean and how it could affect different and particular segments of the population and in this case: children. The authors posit that although children are usually beneficiaries of employment-based insurance; they are enrolled in managed care plans with their parents; as well as in managed care plans through the nationwide conversion of state Medicaid programs from fee-for-service to managed care. Sometimes the uncertainty of managed care makes it difficult to measure the effect of these arrangements on health service ...

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