StudentShare
Contact Us
Sign In / Sign Up for FREE
Search
Go to advanced search...
Free

EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY - Essay Example

Cite this document
Summary
The history is long but major changes in the managed care systems date back in 1973 when the Health Maintenance Organization Act was enacted. Since then, transformations defining legal frameworks that govern…
Download full paper File format: .doc, available for editing
GRAB THE BEST PAPER95.7% of users find it useful
EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY
Read Text Preview

Extract of sample "EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY"

Primary Managed Care Organizational Models in US Today Introduction Health care in US have undergone great changes in the recent times. The history is long but major changes in the managed care systems date back in 1973 when the Health Maintenance Organization Act was enacted. Since then, transformations defining legal frameworks that govern financing continue to prevail. Additionally, these changes have introduced guidelines on how primary managed care ought to be organized. This has led to the introduction of a full package of health services which is facilitated through capitation payments.

All these factors have been instituted to aid the American citizens enjoy dignified health care at the most affordable costs.Health Maintenance Organization Managed care organizations, commonly referred as MCOs (Pozgar 2012) have been a key feature in this sector. According to the (Altenstettter &Bjorkman 2000) it has been seen that integration of both the insurer and provider functions been in the increase. Health Maintenance Organizations not only finances, but also ensure delivery of health services, which are comprehensive, to all the bonafide beneficiaries.

The charges, under this model, are made on the employer for each subscriber. The fixed premium charge goes a long in giving the beneficiary rights of both being insured and provided medical care in case of ailments (Pozgar 2012). Subscriber should though note that, once in this system they can only get service from HMO contracted physicians. The HMO model has several forms which include staff and Independent practice association model. Under staff-model, an arrangement is made for the physician to proved services to the subscribers on full-time basis.

The IPA- model has arrangements made between the independent physicians and HMO to offer services on contract to the beneficiaries. Preferred Provider Organization Health care services can be bought from a group of providers who are carefully selected. Care in selection is emphasized so that the beneficiaries get the best treatment. This is accomplished through preferred provider organizations which are characterized by a well utilization management plan. Under this model, negotiation of payment rates and speeded payment terms are facilitated.

In addition, the beneficiaries have freedom to choose services from other providers though at their own cost (Pozgar 2012). The major essence of this model is the negotiation of charges between the payer and panel providers whom the terms are on contract basis. The payer also selects a panel of providers whom are consulted by the enrollees in case of ailments or other medical necessities.Exclusive Provider OrganizationsThis model has taken the direction of a gatekeeper. Its enrollees are restricted to seek services from only authorized primary provider.

The selection and conduct between all the stakeholders under this model is governed by laws and regulations in the insurance industry. The model is basically characterized by performance-based reimbursements which include capitation payments (Altenstettter &Bjorkman 2000). This seems similar to HMO model but the rules which govern the two models are quite different as seen above.ConclusionOther most plans are modifications of HMOs model. This includes Specialty HMOs which only cover for specified components of healthcare.

The experience-rated HMO benefits from previous experiences of traditional plans in making reimbursements and payments to all stakeholders. The Point-of-Service plans offer choice either to opt for HMO or indemnity-style benefits. All these plans have really been beneficial in cutting all medical costs for the American people. Through these models quality of healthcare services have been improved as best providers are the one selected to offer the services.ReferencesAltenstettter C., Bjorkman J. (2000). Health Policy Reform, National Schemes and Globalization.

London: Macmillan; New York: St. Martin’s Press.Pozgar,G. (2012). Legal aspects of healthcare administration (11th ed.). Sudbury, MA: Jones & Bartlett 23, 513-514

Read More
Cite this document
  • APA
  • MLA
  • CHICAGO
(“EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY Essay - 3”, n.d.)
EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY Essay - 3. Retrieved from https://studentshare.org/miscellaneous/1615351-employee-rights-managed-care-and-patient-safety
(EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY Essay - 3)
EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY Essay - 3. https://studentshare.org/miscellaneous/1615351-employee-rights-managed-care-and-patient-safety.
“EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY Essay - 3”, n.d. https://studentshare.org/miscellaneous/1615351-employee-rights-managed-care-and-patient-safety.
  • Cited: 0 times

CHECK THESE SAMPLES OF EMPLOYEE RIGHTS, MANAGED CARE AND PATIENT SAFETY

Patient Safety: Life-Threatening Medical Errors

… Name Institution Course Instructor Date patient safety According to the IOM (Institute of Medicine) report of April 2001, over 100,000 patients die each year in our hospitals due to medical errors.... As the switch authors indicate, the elephant stubbornly refuses to comply with safety protocols since it has mastered the art of opting for short cuts and the results for risky behaviors are inevitable.... Therefore, the staff seeks short cuts to keep up with patient and hospital's demands....
5 Pages (1250 words) Essay

Legal Responsibilities of a Nurse

In short, a nurse should avoid all acts that are likely to affect the patient safety or quality of the care badly....       This discussion highlights that the major legal responsibility of a healthcare employer is that he should maintain a sound healthcare environment where patient safety is specifically met.... Healthcare laws indicate that employers are legally required to employ sufficient number of staff that is essential to achieve patient safety and quality care....
3 Pages (750 words) Essay

Healthcare and Business Goals

It has sought to put patients first by exploring needs, improving care and overcoming conflicts between its employees....   The role of health care leaders in achieving business objectives Name: University: Abstract The role of leaders in organizational performance cannot be over emphasized.... hellip; Introduction Health care organizations are complex and dynamic institutions that require managers to provide leadership, coordination and supervision of employees....
4 Pages (1000 words) Essay

Comcept Analysis Topic Compliance in Nursing and allied Healthcare

Other nurses work in careers as college and university educators preparing future nurses or as scientists developing advances in many areas of health care and health promotion (http://nursing.... Although 60 percent of all employed Registered Nurses (RNs) work in hospitals, many are employed in a wide range of other settings, including private practices, public health agencies, primary care clinics, home health care, outpatient surgicenters, health maintenance organizations, nursing-school-operated nursing centers, insurance and managed care companies, nursing homes, schools, mental health agencies, hospices, the military, and industry....
4 Pages (1000 words) Essay

Control of Substances Hazardous to Health

Since the introduction of the Health and safety at Work Act (HASAWA) in 1974 there has been increasing legislation on health and safety.... Landmark regulations stemming from this which have had an impact on many industries are the Control of Substances Hazardous to Health (COSHH) Regulations 1988, the Noise at Work Regulations 1990 and the 'six pack' of regulations emanating from the European Community Framework Directive: … The Health and safety at Work etc....
11 Pages (2750 words) Essay

Medico Legal Aspects and the Radiographers Scope of Practice

This work examines a court case involving physicians and a patient, where the failure of a doctor to stick to the professional requirements caused harm to the patient.... ased on court proceedings, the radiographer failed to perform an X-ray on the patient.... The patient in this case scenario was weak, something that the radiographer, Mr.... He was instructed to fetch the patient from another ward and realized his inability to walk by himself....
6 Pages (1500 words) Essay

The Role of the Occupational Physician

In the paper “The Role of the Occupational Physician” the author discusses a leading role in enforcing the Health and safety Executive or the local authority, depending on the type of activity.... The Health and safety at Work etc.... The COSHH Regulations have been perhaps the most significant in the development of occupational health and safety measures.... To many employers, the implementation of safety regulations has been seen as and indeed is, a burden on both staff and financial resources....
11 Pages (2750 words) Assignment

Law of Business Management

For the purpose of this discussion, an implied term of any employment contract is 'the duty of care'.... In light of these considerations, Carla has no claim to the case of champagne even if she had managed to enter the doors of the store first, as the advertisement was an invitation to treat and as such can not form the basis of an enforceable contract.... nbsp; However, by reference to the laws discusses above she is at liberty to register the patent at this point and she can enforce her rights against Davina and Nakida's preventing further use of the patent....
11 Pages (2750 words) Assignment
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.
Contact Us