Question

Choose a common myth associated with managed care. You may use one of the myths discussed in this week's reading assignment, or come up with one on your own. Write a 1-2 page analysis on why you think this myth came about and why it still may be prevalent today. Explain to what degree the myth is based on facts, truths, and misunderstandings.

Summarize the evidence from research that counters or supports the premise of your myth. Conduct research in at least two sources, not including your textbook. Cite your sources using APA style guidelines.

Answer 1

Managed care refers to a wide variety of healthcare system some of which control cost by contracting physicians with reduced fees and restricting the patients choice of physician. It includes health maintainence organization who directly employ physician or contract with a group of clinicians to provide the service.

Common myths about managed care are as follows

1. Doctors are paid very low

2. HMO are good for healthy people not sick

3. HMO threaten quality of care

4. In HMO, medical descison making is done by physician and nurses but not specialist doctors with good experience

5. It involves too much paper work and documentation which is not worth it.

There are many more myths about managed care but these five have been found to be studied upon. The myth that I would discuss is "Doctors are paid low"

Managed care organization focus mainly on chronic disease and it's preventive methods so that cost of acute care in the future is avoided and hence less costly. Hospitals are the most costly affairs that an individual comes across in life.

Doctors are paid low -

Many physician are of the view that reimbursement are too low to be worth it. There are various cluase controlling such imbursement which acn be termed as GAG CLAUSE. In a surevy done by GAO on 1150 physician contracts, it is found that 590 HMO did not cover a single Gag clause and the few cluases which were existing had been dropped long time ago. It is true that some HMO do offer reduced or compromised remuneration but most of the managed care have good reimbursement which contains 90-95 percent of typical fees.

Why this myth - according to the Iron Traingle of healthcare, cost, quality and accessibility are the three factors affecting health care. When the physician have to provide low cost care, it might be understood by the physician that maybe even the remuneration will be compromised leading to this myth. There also might be some rules or clauses which the reduces the remuneration and this might be encountered by a physician very often which can lead to this myth. The doctors have always felt that their remuneration is less compared to the stress and studies done by them in any setting which has overall added to this myth.

The main two types of fees include fee for service which is given to specialist and global capitation which is given to physician. In managed care, there is a panel of doctors who are physician as well as specialist who are paid remuneration according to guidelines of HMO which different for different kinds of care.

Six major myths of managed health care cy John Kingsdale

Jul 27, 1998