Question

1. Discuss one thing that you feel should remain the same with the new health care legislation that is expected from the current Administration, OR, discuss one change that you feel is greatly needed. Be sure to provide a solid rationale for what you believe should remain the same or what aspect of the legislation should change.

2. Discuss the concept of Managed Care Organizations (MCOs). What is the goal of an MCO? Briefly discuss one strategy that is used by an MCO to reduce costs.

Answer 1

Ans 1)

The one thing that I feel should remain the same with the new health care legislation that is the Members pay less for generic drugs than they do for branded drugs. it is very good concept i personaly feel it should be same in the every new health care legislation.

Ans 2)

The concept of Managed care organizations are integrated entities in the healthcare system, which endeavor to reduce costs associated with healthcare expenditures.

The goal of this organization is a managed care organization is responsible for managing the care of a population through a health care system that: – monitors and coordinates care through the entire range of services (primary care through tertiary services); – emphasizes prevention and health education; – encourages the provision of care in the most appropriate setting and by the most appropriate provider (e.g. outpatient clinics versus hospitals, primary care physicians versus specialists); – promotes the cost-effective use of services through aligning incentives (e.g. by capitation of providers, cost-sharing by consumers)

Following basic 3 statergy used by MCO to reduced the cost.

(1) reducing the price the MCO pays to providers, such as physicians and hospitals;

(2) limiting access to care or shifting to cheaper care than would have been provided outside the MCO; or

(3) in noninsurance company MCOs, providing more services that are profitable and fewer services that are not.