Introduction
Managed care system controls the financing and provision of healthcare services to individuals enrolled in a specific type of health care plan. Managed care was established to harmonize healthcare and minimize costs. Managed care trends are continuously changing in America. Healthcare cover costs indicate varying trends in the past years. Most importantly, the costs have escalated mainly because of the increased uptake of physician services. Technological advances also contribute to escalating health insurance costs. The trends in the economy also drive managed care. The economic downturn that has persisted for some time now continues to affect enrollment rates for managed care. Healthcare reforms expanded individuals’ coverage accessibility. Unemployment trends also drive managed care by controlling the number of individuals enrolling for coverage. Today, managed care is experiencing certain trends and issues. This paper discusses the top three issues and trends that are notable in this sector.
High Costs of Health Insurance
It is notable that healthcare insurance costs are constantly escalating. The effects of these changing trends on the whole sector cannot be misjudged. The Americans are increasingly shying away from managed care services (Health Research Institute, 2012). This is because of reasons associated with costs. Indeed, the costs are escalating too fast eventually outstripping the wages obtained by most Americans. In the recent past, the emergences of notable trends generate new concerns about the abnormality of escalation of health insurance costs. In 2012, stakeholders in the health insurance sector speculated that medical costs would escalate by 0.4% from 8.1% in 2011 (Health Research Institute, 2012). Similarly, stakeholders from other sectors constantly question the sustainability of the prevailing trends. Their concerns are whether or not health insurance industries undertake their business with the American people in mind. Apparently, the public is ignorant of the notable issues contributing to unprecedented changes in managed care.
Indicatively, diverse factors have pushed managed care operators to escalate costs for their services and products. The operators have provided different reasons for their decisions to raise the costs. Most importantly, the speculation about new laws, which arterially alters services and products, affected their decisions. The insurers foresaw a situation in future where new guidelines would present fresh demands. Notably, they would be required to justify increments on the insurance costs (Health Research Institute, 2012). Indicatively, the insurers’ decisions were reactive in nature.
Furthermore, additional guidelines such as provision of health insurance to youngsters potentially contributed to escalating health insurance costs. New laws that provide for the different strategies of offering prevention services to the American population also pushed the insurers too far (Health Research Institute, 2012). Evidently, laws underline that prevention services such as mammogram screening shall be covered under health insurance.
The struggling economy also contributes to the escalating health insurance costs. During worse economic times most employers suspend insurance cover (Health Research Institute, 2012). Some employers also restrict workforce eligibility to coverage. Workforces in low wage employments are likely to be the casual victims. Their demand for managed care services is likely to end when their engagement with employers stops. Furthermore, technological and medical expansions are accelerating health insurance costs (Health Research Institute, 2011). Outstanding, discoveries and scientific advances enable people to live longer at accelerated costs.
Health Maintenance Organizations (HMO’s) and Preferred Provider Organizations (PPO’s)
HMO’s and PPO’s managed care players are showing trends in the healthcare insurance. In 2009, the two players provided coverage to approximately 222 million people. These included Medicare and Medicaid beneficiaries. HMO’s and PPO’s grant their members to receive services from providers at bargained rates (Health Research Institute, 2011). There are managed care trends such as enrollment losses and escalating medical services requirements that affect their effectiveness. There were more PPO members than those of HMO. The enrollment rates for PPO services fell in 2008 by 0.9%. Furth number of more, the individuals enrolled under HMO reduced by 2.3%.
The decline in enrollment of individuals in managed care is notable and well documented. Increments in health and pharmacy consumption have affected the burden of the cost in both arrangements. The speculations surrounding healthcare restructuring in America has affected the plans (Health Research Institute, 2010). Indicatively, many providers of these services develop diverse strategies that are applicable in responding to the speculations. The speculations that new healthcare guidelines shall direct service providers to offer managed care to all Americans influence health insurance outcomes (Health Research Institute, 2012). Healthcare reforms suggest innovative and appropriate strategies for guaranteeing universal accessibility to health insurance. Indeed, the reforms suggest ambitious milestones such as ensuring that universal accessibility to healthcare insurance by the citizenry is tenable. Notably, stakeholders in the managed care sector are already speculating that the populations of Americans registered for the two managed care systems payers will escalate extensively. This is a suggestion that the two players in healthcare insurance services are likely to enroll more members.
High Rates of Joblessness
Today, joblessness is a major challenge to the American population. Indeed, more American youths are increasingly losing their posts because of a myriad of reasons. However, most notable is the economic meltdown, which has made major employers to implement reactive measures including terminating their engagement with some workers. The trends of unemployment have presented massive challenges to the health insurance industry. Indeed, managed care providers revert to diverse strategies as a response to the unfolding situation. Americans employed in diverse sectors remits their health insurance contributions through the companies, which have contracted them (Health Research Institute, 2010). Conversely, the Americans who are jobless frequently submit their insurance cover contributions whenever their financial situation improves. As a result, most jobless Americans are less likely to register for healthcare insurance (Health Research Institute, 2010). But, even most worrying are the emerging trends where even employed Americans opt not to register for health insurance coverage.
The reactive measures that employers have adopted to cut back on their losses include terminating their agreement with some of their workers. The American population, which is withdrawing from managed care also seems to be escalating. This is because fewer smaller firms make health insurance contributions on behalf of their workers (Health Research Institute, 2010). It is notable that only larger and conglomerate firms can cope with the escalating costs of managed care. The uninsured and underinsured population is also escalating as a result of the elevating costs. Interestingly, many Americans are engaged in private small scale businesses as a strategy to deal with the impacts of joblessness. Indeed, these innovative Americans also make massive contributions in the health insurance industry (Health Research Institute, 2010). The periods when their commercial engagements are flourishing, such Americans make constant contributions to their respective managed care service providers. However, such low scale traders regularly face similar predicaments when the nation’s economy is dwindling. This has hindered several of such business people from submitting their contributions constantly.
Managed care firms have attempted to establish applicable ways of targeting the out of employment and low wage earners (Health Research Institute, 2010). The population of uninsured individuals is fast increasing. This population is comprised of individuals 34 years or lower. Different managed care firms have developed appropriate health insurance products for the group. Specifically, some of the products provide benefits including gym membership cost cuts together with basic healthcare coverage (health research institute, 2012). The products also promote other preventive care and regular checkups. The additional products are normally aimed at attracting more individuals to enroll for coverage services.
Conclusion
Managed care trends are continuously changing in America. Healthcare insurance costs also indicate varying trends in the past years. Healthcare consumers pay a standard fee to run managed care institutions. The organizations in return provide healthcare services to the enrolled persons. Indeed, the organizations key objective entails proper management of funds in order to generate profits and still provide services. The escalating healthcare insurance fee hinders many employers and individual contributors from submitting their donations. Joblessness also drives managed care through minimizing the population of Americans enrolling managed care services. However, other trends involving employed people failing to enroll for health coverage are also notable. Indeed, the trend appears common with newly employed Americans. Apparently, such people are thought to be taking reasonable time before authorizing their employers to submit their contributions to specific service providers. It is noteworthy to suggest that the healthcare insurance industry has the potential to reemerge and provide Americans with appropriate insurance cover. This is because these trends shall never remain permanent but, are subject to financial improvements in the national and global arena.
References
Health Research Institute. (2010). Behind the Numbers: Medical Cost for 2011. Web.
Health Research Institute. (2011). Behind the Numbers: Medical Cost Trends for 2012. Web.
Health Research Institute. (2012). Medical Cost Trend: Behind the Numbers 2013. Web.