Problems with cost and reimbursements have always been an issue in health care. To resolve many of these problems brought upon the development of managed care. Many different strategies and methods are being used in managed care to reduce costs. Since Nurses play a major role in helping others, for example, patients, consumers, and health care professionals. They need to understand how reimbursements have affected health care. Nurses who understand this system will be able to perform more confidently and effectively.
Managed Care.
Its Origins, Today's Picture-and What's Ahead.
Health care service is always highly in demand. People get sick every day and need suitable health care coverage to receive quality service. The article, " Managed Care," by Cindy Ling, MN, RN, goes into depth explaining the different strategies and methods used in managed care, and how they affect health care delivery. Suppose ly, managed care is the solution to many of the financial problems with the health care system. " Managed care has been successful in slowing the growth of health care costs, and has reduced duplication, waste and overutilization. Yet, many patients and health care providers are dissatisfied, the number of uninsured is growing and insurance premiums are again on the rise," ( Ling, Managed Care ). Nurses especially need to get knowledge of managed care since they have an important role as a health care provider. Understanding of this system, and how they are involved will help them perform their jobs more strongly. Some different strategies used in managed care contain: Diagnosis-related groups .
( DRGs ), Per diem payments, and Caption. Ling also brings up a few techniques that have implemented to manage costs, for example, Contracts, Drug Formularies, and Utilization review ( UR ). Lastly, she flows into talking about many organizations that used managed care like: HMOs, PPOs ( Preferred Provider Organization ) , POS , and IPAs ( Independent Practice Association ) .
