U.S. health care system/Managed Care

What is the public’s view of the U.S. health care system?

How was that perception shaped by the insurers?

How was that perception shaped by provider groups?

How was that perception shaped by the purchasers of healthcare?

Has managed care influenced or changed the ways in which healthcare providers make medical decisions? Why or why not?
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. health care system?
The public views of the US health care system include Inequities in the US health care system have been well
documented. Racial and ethnic minorities, the uninsured,
and other disadvantaged populations receive
poorer quality health care. Several studies have shown
that physicians’ perceptions about patients are influenced
by patients’ race/ethnicity and socioeconomic
status, and these perceptions in turn influence physicians’
behavior in medical encounters.
? 12,000 deaths per year due to unnecessary surgery
? 7000 deaths per year due to medication errors in hospitals
? 20,000 deaths per year due to other errors in hospitals
? 80,000 deaths per year due to infections in hospitals
? 106,000 deaths per year due to negative effects of drugs

The public view of the health care system includes perceptions that America’s healthcare-system-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.

1. How was that perception shaped by the insurers?
   The increasing cost of insuring has shaped the perception. The Centers for Medicare and Medicaid Services (CMS) recently announced a 17.5 percent increase in Medicare premiums, the largest increase in fifteen years. One driver of these cost increases is a loosening of the restrictions associated with managed care (such as primary care gatekeepers, utilization review, and closed formularies) in response to the managed care “backlash” of consumer reaction that peaked around 2000.
   That perception has been shaped by the insurers because in the past, health insurance in the United States took the form of voluntary programs. Such programs date from about 1850, when health insurance was provided chiefly by cooperative mutual benefit and fraternal beneficiary associations. Limited coverage by commercial companies was also introduced during that period, and subsequently many plans were established by industries and labor unions.
   Advocacy of government health insurance in the United States began in the early 1900s. Theodore Roosevelt made national health insurance one of the major planks of the Progressive party during the 1912 presidential campaign, and in 1915 a model bill for health insurance was presented, but defeated, in numerous state legislatures. After 1920 opposition to government-sponsored plans was led by the American Medical Association and was said to be motivated by the fear that government participation in medical care might lead to socialized medicine.
   Over the years in the United States, many plans have been set up by societies of practicing physicians, but the largest enrollment has been in Blue Cross and Blue Shield plans. These were set up as community-sponsored, nonprofit service plans based on contracts with hospitals and with subscribers. Most general voluntary plans accept subscribers, in groups or as individuals. These plans extend coverage to dependents and exclude accidents and diseases covered by workers’ compensation laws. Although valuable in cushioning the financial distress caused by illness or injury, voluntary health insurance not only limits benefits in order to avoid prohibitive rates but excludes many people, particularly the poor, who cannot afford it, and senior citizens, for whom the cost is often prohibitive. By the mid-1990s many of the Blue Cross companies, which had been suffering financially, were reorganizing, and by 2002 more than 20% of Blue Cross members were covered by plans that had converted to for-profit …