Prevention as the Future of Managed Health Care

Abstract

Most states world over realizes the importance of keeping the society healthy in preparation for future emergencies. Managed health care programs require timely efforts in ensuring stability and sustainability in public health. Prevention techniques form an essential part in warranting the achievement of manageable health care programs globally. This paper seeks to influence individual opinion concerning this debate and the relevance of Health maintenance organizations (HMO) in public health (Lundy, K. et al., 2009). From a broad perspective of the meaning of managed healthcare programs to its relation to state policies, rules and regulations, the information contained herein will confirm many doubts held by varied individuals. Principally, managed health care services enable preceding planning, save costs and offer quality medication. In the USA Medicaid and Medicare organizations, take advantage of prevention in creating public awareness. Hence, prevention is the best way to ensure eminence in delivery of such services since it may help evade extra costs attached to the cure involved.

Predominantly, managed care entails prompt delivery of healthcare services in a controlled manner. Managed health care is a long-term strategy that collective forces can achieve. It also combines the benefits of quality assurance on service conveyance and cost-effectiveness in the end (Grosel et al., 1998). While managed health care focuses on cure of critical ailments and chronic maladies, prevention helps to minimize such cases from occurring. In ensuring this, most health care providers take into account utilization management techniques and insurance policies in which case, hospitals use alternative means of carrying out daily activities to save time, space, and money. Prevention incorporates management of health care by targeting a distinct patient, a caregiver, an insurance entity, and the person who procures the care. It is a four way process that invites agreements of the parties involved. To avoid frequent hospitalization cases, health professionals advice the society to embrace certain preventive actions that aid in leading a healthy life style. Prevention is a cheaper exercise than cure and most countries consider adopting it to avoid incurring additional expenses that accompany treatment.

In the contemporary society, cases related to cancer, HIV/AIDS and chronic attacks are rampant and on the rise. Various risks habitually associated with those diseases include death, loss of sight, and total loss of normal body function. While identification of some of them is probable, most of them result in futility and failure to detect earlier. Often, experts’ advice persons to take up aerobics, healthy diets, and avoid stress related situations as prevention techniques from such illnesses (Kongstvedt, 2001).

Patient health care needs

Prior to patient involvement in this practice, their consent is of considerable significance. The designation of prevention services are suited for a single visit to a health care provider but may last longer. Naturally, every individual within the society is entitled to his or her own opinion. One cannot force prevention measures on persons hence their free will plays a part in achievement of goals set by humanity (Lundy, K. et al., 2003). Managed health care delivers a crisp synopsis of the society’s expectation concerning their wish to secure a lasting solution to various health problems. Prevention aids in effective health care programs before the onset of disease. Prevention methods prepare individuals for different outcomes. Prevention chiefly focuses on research, qualitative and quantitative analysis before advising people on the measures they need to take. Patient health care needs translation into ways through which prevention is achieved as underneath discussed.

Communication through media

The most common way used to publicize health care and prevention programs is through advertising. States in the USA embrace campaigns and educational forums geared towards creating awareness on preventive measures put in place. The government, health care providers and the society join forces to implement these suites and make them effective. Through multimedia and multiple communication channels, health messages reach the masses within the shortest time possible. Billboards along high ways, adverts, and sponsorships help send the message home in unique ways that produce positive feedback (Halverson, P. et al., 1998). The society is often receptive towards information acquired from the media causing the populace act in the best interest of everyone within the society. Persons are receptive to information that relates to everyday life like abstinence from drugs, drinking while driving and its connection to accidents and negative effects of smoking among others.

Immunization

Besides the step earlier mentioned, immunization or vaccination still stands the best chance for prevention of many diseases. Numerous countries take up immunization procedures to prevent conditions like polio. Menaces associated with polio include loss of limb use and disability (Stenberg et al., 1994). Vaccination is probably the most trusted, convenient and efficient form of protection from diseases, however, not all maladies can be prevented through it. Consequently, African states especially of the Sub- Saharan origin battle in their quest to find an immunization for malaria to no avail. Malaria is the number one killer disease in most African countries and thus need for a remedy in solving this wanting situation. Immunization offers a safe ground for the patient and the medical practitioner and qualifies as the preferred prevention process. The society would give anything to the individual who discovers a cancer and AIDS vaccine. This is because they are the world’s greatest killers in history.

Early Detection

With early detection through scans and symptoms exposure, prevention is a less daunting task. Physicians recommend persons to visit health outlets for checkups even if it involves weight issues. Checkups impose primary detection of ailments and ensure prompt action against viruses hence preventing further spread of disease. Specialists relate early detection procedures as better health management techniques. Prompt recognition of tumors and cancerous cells prepare an individual for a total lifestyle change that might lead to cure (Lundy, K. et al., 2003).

Collective possibility and accessibility of preventive care services

Preliminary cases base their arguments on individual responsibility towards the state and health providers. This part shifts attention to the collective obligation of the two parties in providing enough health care facilities to the individuals. The USA enjoys proximity to most health amenities owed to previously established infrastructure, networks and financial supremacy. In addition to the American dream, accessibility to fitness services within its locale complete this package (Grosel et al., 1998). Nearness to these facilities means they are affordable and open on a 24-hour schedule throughout the week. People occasionally pop in for tests to guarantee high aptness standards and prevent the likelihood of falling ill.

Provider contracting

In some instances, an arbitrary entity comes into play between medics and health care consultants. These three promise to abide by a treaty that authorizes giving out incentives to the third party basing on services sought by a patient from either of them. The incentive safeguards the interest of both parties while still within the contract. Breaching of such agreement is considered offensive to either group. As such, the neutral body fosters the relationship existing between the two bodies. This mostly happens to bridge a gap, solve a conflict, or improve working relationships in order to amend pre-existing health conditions. This task is more of outsourcing a different person or body to unify two groups whose combined efforts could probably propel the current health standards and take them to a higher level. The Center for Disease Control (Stenberg et al., 1994) is one such body known to identify groups for this purpose. In 1995, this organization merged the Group Health Association of America (GHAA) with the health care providers within the USA. The results were positive since, associations of health care providers and the society improved at a provincial, state, and global level. Essentially, it became easy to reach the public with prevention messages. The fusion witnessed between the society, and the healthcare providers created an enviable realm in the history of the USA. Countries worldwide wish for such a health care strategy, consequently, it turns into a mere dream. Unified forces within the USA certify public education and empowerment when it involves issues of health care.

Cost Containment

Public health caregivers run business in the best interest of the society. This means that exchequer fund most of their programs, amenities, and facilities. In most instances, the money may be inadequate in relation to the nature of work done, and the number of people served. Issues of funds embezzlement also arise and interfere with normal running of health care activities. The USA, however, is known for taking up affirmative action in dealing with such cases. The government ensures justice is served for the benefit of the populace. Therefore, it is easy for public health outlets to fund their prevention campaigns since they have a credible source of income. Sometimes limited funding from government make health care outlets run cheaper prevention programs that bear no fruits and render prevention campaigns useless (Sauber, 1997).

Privately owned health care giver services, on the other hand, enjoy the trust and belief from the public but then they have to look for ways of funding the programs. Their success fully depends on quality of their output. They spend a fortune in their prevention campaigns because they understand the benefits that come with publicity and marketing. The worldwide campaign of the Dettol soap and Colgate often backed up by health experts discloses this. Statistics indicate that most private institutions spend a lot of money on prevention campaigns, but they get value for their money later so they do not run a loss.

Medicare and Medicaid

Rules, regulations, and policies accompany Managed health programs. Health maintenance organizations (HMO) such as Medicaid and Medicare in the USA offer services that accommodate most Americans. Prior to introduction of new laws, stringent measures put in place created levels of limitation to these products. This compelled abolishment of past informatory necessities that restricted access to them. Initially, Medicaid programs were governed by decrees and principles that insisted on the need to concede inpatient status preceding release of monies that would otherwise dictate prevention or diagnosis of the same illnesses. This led to loss of lives amidst time wastage in controlling out breaks and cure of many diseases (Lundy, K. et al., 2009). Essentially, Medicare procedures put in place demanding insurance plans that made it almost impossible to access health care services when need arose.

The management of Medicare and Medicaid lies with the health care providers and the government. Many things changed individual impression of these products considering increased enlightenment levels brought about by technology. An increased need for security, health consciousness, and insurance amplified their popularity in mid-19th century to the beginning of the 20th century. These two entities generated schemes in which employed persons had access to insurance programs catered for by the respective firms in which they worked. Progressively, Medicaid and Medicare introduced varying interest rates depending on the number of employees involved and size of the organization (Stenberg et al., 1994). Non-employed persons developed no interest in their activities and hence the reduction in their popularity lately. Rumor has it that the interest rates do not vary and that they have been constant for quite some time.

Medicaid and Medicare never stopped at that; they looked for multiple ways of reaching the society and creating good will. This resulted in an agreement with the USA government in which case, disabled persons qualified for free health care. These two bodies enjoyed a monopoly because of the varied products they offered to the society (Grosel et al., 1998). Individuals also realized the need for health insurance in dealing with crises. Besides insurance services, Medicaid and Medicare offered education programs concerning various prevention techniques the society needed to embrace to handle infections.

In the 21st century, Medicare and Medicaid realized the desire closely to observe, make precise and enrich their services. The advent of technology made things easier since it led to the introduction of innumerable machinery to perform multiple functions within a short time span. Today, they compromise scanning services, screening services biometric surgical procedures and incorporate other detection and prevention processes. This century marks a generation of open communication channels and expression of individual interests without fear of intimidation (Sauber, 1997). In effecting, Medicare and Medicaid services have open systems through which the society rates them in order for them to improve their services, discard some, and maintain others. Americans do this by using their “report card” which is a customary biometric procedure to carry out this.

In fulfilling their obligation to the society through Community Social Responsibility, Medicaid and Medicare programs offer free screening and scanning services to Americans. In essence, they aim at a society free of diseases associated with the dawn of the 21st century. They participate in outdoor awareness activities in their quest to reach many people (Baker et al., 1994). They setup centers for performing these tasks in streets and social places to attract the highest number of persons. These free clinics and checkup centers save lives since they ensure early detection and offer educative forums on prevention measures. Recently, reports indicated that delivery of such programs never showed signs of decline or improvement especially to those already enrolled to various managed care plans.

The future role of government regulations

The future of healthcare provision services in the USA promises smiles to the natives. This is because the USA repealed most strict laws that governed this process to pave the way for better services in the best way possible. Recently, President Barack Obama came up with a healthcare scheme in which every citizen is obligated to be part. This is a managed plan that encourages prevention as opposed to curing. Embracing the art of prevention in the states makes most people take up conscious decisions and thus lead healthy lifestyles (Halverson, P. et al., 1998). The government supports the role of health care givers in creating awareness and they engage the society in doing the right thing. Initial lobbying activities caused the government to dismantle ambiguous rules that made survival difficult. Naturally, Americans possess educational empowerment and hence understand their rights well enough to participate in relevant decision-making processes.

Recommendations

Every society dreams of a better tomorrow based on proper health care schemes and processes. As such, it is necessary to put into consideration the things Medicare and Medicaid programs need to incorporate, to serve the populace in a respectable manner, and gain in return (Stenberg et al., 1994). These two need to create multiple communication channels through which persons can reach them instead of depending on “report card” system only. Emergencies arise especially in sub-barbs, and most Medicaid and Medicare programs do not reach them. These programs need to invite feedback and comments from social media, print media and even gutter press. This in essence will take care of the interest of everyone in the USA. It will also save lives that would otherwise be lost in a reckless modus.

Secondly, most prevention campaigns carried out by these programs primarily target about five of the world known killer diseases. They ignore fatal maladies like Ebola and malaria. Although the USA has rare cases of these, it is advisable to educate the society on risks and prevention measures to take in order to avoid contact with such ailments. Prevention techniques work magic in most African states including South Africa and Tanzania.

Medicaid and Medicare programs are a household name in the USA but then they need to spread wings beyond the locality and reach other parts of the world. The realization of this dream depends on the financial situation of the USA and the influence they have internationally (Kongstvedt, 2001). The USA still remains the economic powerhouse in the world and thus gunners a lot of command in the present world. These programs need to take advantage of these facts to provide health care services to the other parts of the world and increase their popularity. This will help improve their credibility levels and will make people believe them even more.

Finally, if prevention could be a form of cure then it would be the best. It acts in the best interest of the society and helps reinforce favorable actions towards attainment of a future manageable health care plan. Many crusaders such as individuals, governments, and health care givers must join forces in ensuring success in prevention programs. This creates the relevance of provider contracting in achieving the “American Dream” in terms of managed health care plan in the future (Baker et al., 1994). Notably, good governance makes a nation realizes the importance of Health maintenance organizations in prevention of deadly diseases.

References

Baker EL, Melton RJ, Stange PV, et al. (1994). Health reform and the health of the public: forging community health partnerships. New York: Aspen Publishers.

Grosel C., Hamilton M., Koyano J. (1998). A forecast ofhealth and health care in America. Menlo Park, CA: Institute for the Future.

Halverson, P. K., Kaluzny, A. D., McLaughlin, C. P., & Mays, G. P. (1998). Managed care and public health. Gaithersburg, Md: Aspen Publication.

Kongstvedt, P. R. P. R. (2001). The managed care handbook. Gaithersburg, Md: Aspen Publishers.

Lundy, K. S., & Janes, S. (2003). Essentials of community-based nursing. Boston: Jones and Bartlett.

Lundy, K. S., & Janes, S. (2009). Community health nursing: Caring for the public’s health. Sudbury, Mass: Jones and Bartlett Publishers.

Sauber, S. R. (1997). Managed Mental Health Care: Major Diagnostic and Treatment Approaches. Philadelphia: Brunner/Mazel.

Stenberg, C. W., & Colman, W. G. (1994). America’s future work force: A health and education policy issues handbook. Westport, Conn. u.a: Greenwood Press.

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