Question

Health insurance and managed care have changed significantly over the past 50 years. Discuss reasons why these changes were made. Discuss why these changes have not been able to curb the high costs of healthcare. Summarize the ethical and legal issues involved when an insurance/managed care company denies coverage to a patient with medical necessity.

Answer 1

Health insurance and the managed care are an important aspect to get healthcare services at the time of need. This has drastically changed over the past 50 years.The reasons for these changes are

• To improve the quality of service
• To reduce unnecessary medical expenditure and high medical cost
• Ensure it is affordable by all people
• To ensure all are healthy and disease free
• To take the position as a leading healthcare service provider

These changes over these many years were not able to curb down the high cost of health care due to the following reasons

• The service charge paid to the health care professionas are very costly
• There is so many administrative wastes
• Most of the patient has to pay for their drugs which are very expensive as it is not under the control or contract of government to make it affordable
• Defensive medicine
• The high healthcare professionals salary

Some of the ethical and legal issues involved when an insurance company or the managed care denies coverage to a patient in medical necessity are

• Lack of trust and hope on the insurance company and the managed care for not approving the necessary medical services
• The risk of the insurance company being sued by the patient .The patient are then provided an heft amount if they win legally