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Essay / Research Paper Abstract
A 4 page research paper that examines this question. The writer gives a brief history of managed care and then describes how MCO programs of disease management interventions hold the promise of lowering costs and improving care, which suggests that the answer may be a qualified "yes." Bibliography lists 3 sources.
Page Count:
4 pages (~225 words per page)
File: D0_khmcoic.rtf
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Unformatted sample text from the term paper:
were acknowledged to be entrepreneurs, as well as healers, the "lodestar that guided profession calling" was the concept that clinical judgements should be untainted by financial concerns (Stone, 1997).
Today, this scenario has been reversed by the advent of managed care. In todays healthcare environment, health insurers intentionally try to influence the clinical decisions of health professions with money
(Stone, 1997). Ultimately, has this hurt or improved the delivery of healthcare? Because doctors in managed care now frequently bear the same risks for the costs of patient care
as do health insurers, they are also subject to the same incentives to encourage their patients to live healthier lives and to avoid increased risks to health (Stone, 1997). Managed
care organizations (MCOs) evolved as a reaction to the inflationary fee-for-service model of healthcare delivery that was the standard until the advent of managed care (Sackett, Pope and Erdley, 2004).
Stone (1997) points out that the paradigm of doctors being uninfluenced by monetary matters was always partially illusionary. In the traditional system, doctors were reimbursed by insurance companies for services
rendered-- the more services rendered the higher their reimbursement (Sackett, Pope and Erdley, 2004). MCOs have reversed this with numerous reimbursement scenarios that have the common factor of enrolled doctors
receiving additional income for having patients who use less services. As Stone (1997) indicates, she received a healthy bonus check from an MCO when her practice involved fewer patient services.
Sackett, Pope and Erdley (2004) conducted a return on investment cost analysis on prenatal program developed by a MCO in western New York. These authors argue that their findings
regarding this program, which show that it is cost effective, primarily because it improves patient outcomes, can be applied to disease management programs in general. In this program, case
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