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Introduction to the U.S. Health Care Delivery System

Introduction to the U.S. Health Care Delivery System Information

Aubrey Gaines

June 22, 2011

Health Care Delivery Systems

BHS 450

Trident University International

Dr. Leequan Ray

Managed Health Care is debated on a number of aspects; nature and origin of managed care, the notion of the death of managed care and the current state of managed care in the U.S. health care system. Anyone in America, who’s used healthcare insurance through their employer, experienced managed care at some point. What is managed care and how does it affect us?

The Health Maintenance Organization (HMO) ACT of 1973 required employers with more than 25 employees to offer federally certified HMO options along with indemnity insurance upon request. With the HMO ACT of 1973, employers needed them more than ever. HMOs had to instantly find a way to provide quality care at the lowest possible cost to the employer, so they engineered techniques that became known as managed care.

Managed care is loosely defined as a mixture of techniques intended to reduce the cost of providing health benefits in order to improve the quality of care for a predetermined population. The intent is to decrease unnecessary cost through a multitude of mechanisms which include offering economic incentives for physicians and patients to select less costly forms of care, reviewing the medical necessity of specific services, increasing cost sharing, controlling inpatients admissions, length of stay and contracting with health care providers. Early on, managed care seemed to be the answer to the escalating cost of U.S. healthcare, but patients were very limited in their freedom to choose their own providers for a number of reasons.

Healthcare, as it was three decades ago; mandated patients to pay monthly premiums,...

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