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Escalating Cost of Medical Care

EscalatingCost of Medical Care

Table of Contents

Escalating Cost of Medical Care 3

Problem statement 3

Position A 4

Reducing the use of services and facilities 4

Optimizing the treatment process 6

Enhanced access to preventive health care 6

Position B: 7

Effect of managed plans on composition and total health expenditure 7

Unfair exclusion criteria 8

Reduced access to the necessary services in exchange for primary care 8

Poor management of the public managed care program 9

Personal opinion 10

Impact of managed care on nursing 12

Impact on nursing practice in clinical setting 12

Impact on education of future nurses 13

Impact on continuing education of licensed nurses 14

Impact on nursing research 14

Impact on nursing administration 15

and conclusion 16

Literature review ………………………………………………………………………………………………………17

Endnotes 18

References 21


EscalatingCost of Medical CareProblemstatement

Thecontinuous increase in the cost of medical care in the United Statesis an issue of concern to the stakeholders in the health sector andthe people of the United States. The federal and the statepolicy-makers in the United States adopted the managed care plans asthe best way of improving the quality and containing escalating costof medical care (Sparer, 2012). The number of enrollees in themanaged health care plans has increased since their introduction inthe 1990s. The number of beneficiaries of the Medicaid managed careincreased from 10 % in 1990s to 70 % by the year 2008 (Duggan &ampHayford, 2011) 1.The state as well as the local mandates played a major role inincreasing the rate of enrollment because certain categories ofMedicaid recipients were required to enroll in at least one managedcare plan.

Provisionof quality and affordable health care services is one of the keymandates of the government of the United States. However, the soaringcost of health is a major challenge to the accomplishment of thisrole. The managed health care plans are a set of techniques that weredevised by the government of the United States to reduce the cost ofhealth benefits while improving the quality of care at the same time.The managed health plans were started with the perception that theywould help the government in enhancing access to health care,improves the quality, and reduces the total expenditure. The types ofmanaged health care plans include the Health Maintenance Organization(HMO), Preferred Provider Organization (PPO), and Point of Service(POS) Shoemarker, Pozniak, Subramania &amp Mauch, 2010) 2.The HMO pays for care within the network, PPO pays more funds forcare obtained within the network and part of the cost for careobtained outside the network, and POS allows the patient to selectbetween PPO and HMO when they need health care services.

Althoughthe primary objective of the managed health care plans was to containthe escalating cost of health care, the effectiveness of these pansin achieving this goal is still controversial. Currently, there is agroup of people (stakeholders and healthcare seekers) who feel thatthe plan have successfully reduced the cost of care while othersargue that these have not been achieved. Proponents argue thatmanaged care plans put in place competitive marketplace thateliminate inefficiencies, thus lowering the cost and improving thequality of health care services (Nicholas, 2009) 3.In addition, since the managed care plans compete on quality andprice, they generate savings used to provide additional benefits tohealth care seekers. Opponents of the managed health care plans, onthe other hand, argue that these programs provide an opportunity forplans to take on the cream-skimming, which means that they attractenrollees from healthiest beneficiaries with limited use of healthcare services. This provides an opportunity for physicians to reducethe quality of care in the fee for service to persuade patients toenroll in higher intensity services in order to increase revenue.This means that managed health care plans reduce the quality andincrease the cost of health care services. Based on the argumentsraised by two sides, the present study will seek to answer thequestion is managed care the answer to escalating cost of medicalcare?

PositionA:Case for managed care plans

Althoughthe capacity of the managed care plans to reduce the cost of healthservices in the United States of highly debated, the majority ofstakeholders and citizens feel that the plans are effective. Thissection addresses three ways through which the managed care plansreduce the cost of health care.

Reducingthe use of services and facilities

Managedcare plans reduced the cost of health care by ensuring that allresources in the health care sector are used economically. Theinfluence that these plans have on physicians’ behavior helps inreducing the performance of unnecessary therapies and ensures thathealth care professionals treat their clients adequately. This isachieved by providing physicians with financial incentives, suitabletreatment guidelines, denying payments for inappropriate services,and resource utilization review (Nicholas, 2009) 4.By reducing some of these unnecessary services, the health caresystem is able to save on the cost of medical care. In addition, theplans lessen overprovision of elective procedures and diagnostictests that can be avoided while achieving the desired quality ofhealth care. The two major tools used to achieve the utilizationobjective include the utilization management and utilization review.Utilization management address the aggregate performance ofindividual physicians and their facilities, which is accomplishedthrough benchmarking (Felder, 2013) 5.Utilization review, on the other hand is achieved by ensuring thathealth care providers reveal their plans and actions to independentor external referees who judge the adequacy of health care servicesprovided, thus reducing unnecessary expenditures.

Althoughthe strategies used in the managed care plans have the capacity toreduce the cost of medical care, research shows that the level oftheir effectiveness varies with states. The study of Iowa’s managedcare plan revealed that the program resulted in savings of up to 3.8% of the total health care expenditure from 1998 to 1997 (Sparer,2012) 6.Similar programs reduced the overall cost of medical services atnational level within the same period, which implies that the managedcare plans reduces the cost of care across the country, but invarying amounts in different states. The main cause of this reductionwas the decline in utilization of hospital facilities by inpatients.A similar study identified that managed care organizations (MCO)generate savings of up to 22 % of the national medical costs.

Optimizingthe treatment process

Optimizationof treatment process reduces the cost of health care by maximizingthe treatment outcome, which in turn reduces the length of treatment.There are two tools used to pursue the treatment optimizationstrategy under the managed care plans. First, disease management is astrategy that seeks to optimize the process of treating specificdiseases (such as diabetes) that are considered to be chronic(Felder, 2013) 7.Such programs have a great potential to enhance patient’s healthstatus and reduce the cost of prolonged treatment. Secondly, casemanagement is a strategy that involves optimization expensivetreatment processes. This strategy is accomplished by ensuring thatnurses and other health care providers act prospectively andretrospectively. For example, careful planning of a complicatedoperation can reduce the length of hospitalization. This is becausethe close retrospective examination of expensive cases helps thehealth care providers in taking preventative measures for similarcases if they occur in future.

Enhancedaccess to preventive health care

Managedhealth care plans emphasize on patients` access to preventive orprimary health care, which involves the use of scientifically proventherapeutic procedures to treat medical conditions at an early stageor prevent the occurrence of diseases. Although preventive servicescost money, their benefits outweigh the government expenditure onthem. For example, a successful treatment of breast cancer requiresan early detection, which is achieved by regular examination(Rossiter, 2009) 8.This reduces the extra cost of treating chronic cancer, whichrequires the use of expensive procedures and long time to heal. It isthe primary objective of managed care plans to enhance patients’access to preventive care, which reduces the future use of emergencyrooms that are more expensive. In overall, preventive health careservices decrease or eliminate the cost of treating chronic disease.

PositionB:Case against the capacity of managed care plan to reduce the cost ofhealth care

Effectof managed plans on composition and total health expenditure

Althoughthe majority of stakeholders in the health sector and some patientsfeel that managed care plans reduce the cost of health, there aresome who find the program as being neutral to the cost of care whileothers argue that the program inflates the cost of health. A researchconducted in Columbia to assess the capacity of the managed careplans to reduce the cost of care indicated that the program failed toachieve its theoretical objectives that included the enhancedcoordination of health care to keep the patients health of (Duggan &ampHayford, 2011) 9.The study showed that the reimbursement of established programs (suchas Medicaid) was much lower compared to commercial insurers. Thismeans that medical expenditure would still increase provided thatinsurers continue reimbursing medical care professionals at ratesthat are higher compared to the fee-for-service programs.Consequently, the effect of reducing the cost of health througheffective utilization of facilities and services is negated by highreimbursement rates, thus reducing the capacity of the managed careplans to achieve their goals.

Theeffectiveness of the managed care program to reduce the cost ofhealth depends on the generosity of established medical programs.Research shows that reimbursement rates of established programs (suchas Medicaid) are lower than the rates of private insurers, which arenegotiable (Duggan &amp Hayford, 2011) 10.This means that states with generous reimbursement achieved costreduction, while states with less generous reimbursement by providersfailed to save on costs. This makes the cost of medical care toremain relatively neutral, but considering the cost of administeringthe managed care plans, the cost of health would be higher comparedto fee-for service strategy. This suggests that the managed care onlyshifted people from fee-for service to managed care plan, whicheither had no effect on the cost of health or inflated the cost ofcare through addition of expenses for managing the program.

Unfairexclusion criteria

Althoughthe managed care program was intended to reduce the cost in all areasof medical care, the exclusion criteria adopted have hindered theachievement of this goal. This is because most of the managed careplans over-emphasize on primary care and excludes the treatment ofchronic cases and long-term diseases. For example, research showsthat more than one fifth of enrollment in managed care planscomprised of cases of primary care programs by the year 2003 (Duggan&amp Hayford, 2011) 11.In addition, the study indicated that the high cost medicalrecipients (such as the disabled and the elderly patients) wereexcluded from the managed care program. These categories of clientswere retained under the fee-for-service programs in their respectivestates. Moreover, the long-term care programs were carved out of themanaged care plans and payment for such services is made to healthcare providers under the fee-for-service programs. This means thatpeople who needed long-term and expensive medical care by the timethe managed care program was introduced could not benefit from areduction in the cost of care.

Reducedaccess to the necessary services in exchange for primary care

Theexplicit design of managed care plans facilitated the access toconventional primary care services, but reduces the client’s accessto emergency rooms and utilization of inpatient facilities (Sparer,2012) 12.These results from over-cautiousness of physicians that are inducedby restrictions ingrained in the managed care policies and may leadto denial of important inpatient or emergency services. The failureof patients to access these crucial facilities (emergency rooms andinpatient) subjecting them to the risk of developing chronicillnesses that are expensive to treat. In addition, providers of themanaged care plans have limited networks, which reduces accessibilityof their services to vulnerable and at-risk groups (Graham,Kurtovich, Ivey &amp Neuhauser, 2011) 13.This means that the cost reducing effect of managed care fails toaddress the needs of vulnerable groups.

Poormanagement of the public managed care program

Peoplewho support the managed care plans argue that they reduce the overallcost of health by ensuring that patients receive adequate and qualitytreatment, which reduces disease progression to chronic stages thatare expensive to treat. However, most empirical research works haveeither identified no evidence or mixed results on capacity of managedcare plans to reduce the cost of health by improving the quality ofcare. Research shows that the weighed cost of treatment per patientincreased from $ 6,217 to $ 8,084 from 1991 to 2003, which representsa growth rate of 2.2 % in cost of health (Duggan and Hayford, 2011)14.This raises the doubt on the effectiveness of managed careinterventions to reduce the cost of medical care.

Moreover,lack of efficiency in the management of public health care programsfrustrates the government objective of containing the escalating costof health. For example, a study of efficiency of managed care plansrevealed that publicly traded managed care plans performed worsecompared to non-publicly traded plans (McCue &amp Bailit, 2011) 15.In addition, the cream-skimming effect of managed care plans reducestheir capacity to enhance the quality of health care services, whichin turn limits the cost reduction effect of high quality servicesunder the managed care program. The mixed result in improvement ofquality and cost reduction under managed care plans stem from thefact that the two aspects (cost and quality) are affected by acombination of complex social variables.


Althoughthe effectiveness of the managed care program in containing the everrising cost of health is viewed with mixed ideas, I feel that it isone of the most important interventions taken by the government ofthe United States to rescue its people from exorbitant expenditure onmedical services. This is because the managed care program increasesthe government savings on medical expenditure both at federal andstate levels. The arguments raised by the opponents of the programwho suggests that the cost of treatment per recipient have beenincreasing over the years should be assessed with broader mind. Theopponents should take other environmental and economic factors (suchas inflation) that have an impact in the cost of health intoconsideration. If other factors are held constant, it is evident thatthe managed care plans have prevented the increase in cost of health,which would have taken place in their absence.

Inmy opinion, the managed care program contains the escalating cost ofhealth care in three ways. First, the program enhances accessibilityto preventive health care services, which reduces the rate ofincrease in the number of cases of chronic diseases. This is becausethe program emphasis on the importance of helping the people of theUnited States to receive primary care, which helps in early detectionand treatment of diseases. Although the arguments raised against theprogram’s incapacity to enhance the accessibility of preventivecare, emergency, and inpatient services to the vulnerable populationsare genuine, reforming the plans would be better than discarding it.This means that the stakeholders in the health care sector shouldintegrate the principle of equity into the managed care plan toreduce unfair exclusion as well as social disparities in the healthcare system. In addition, the managed care plans enhanced patient’saccess to a network of health care specialists. This ensures that theneeds of individual patients are addressed by health careprofessionals with special skills, thus improving the treatmentoutcome and reducing the probability of disease progression tochronic stages.

Secondly,I feel that the managed care program improved that quality oftreatment to enrollees of its plan. This is because the availablenetwork of health care providers is first evaluated by insurers andemployers, which implies that their credibility as well as theirexperience meets the needs of subscribers. In addition, the managedcare plans gives freedom to their subscribers to select the healthcare providers from a larger network of professionals unlike theindemnity plans where the health care providers are selected by theinsurer. This provides an opportunity for patients to be served byproviders with knowledge and experience of their present medicalchallenges. Moreover, the managed care program is flexible and allowsthe patients to select the plans that are more convenient. Forexample, patients are permitted to select the HMOs, POSs, or PPOsprogram depending on their medical needs. By choosing a larger plan,patients increase flexibility of meeting certified doctors and otherspecialists in their network.

Third,the introduction of managed care plans paved way for the formulationof other medical programs that are intended to contain the rapidincrease in cost of health care. For example, the Obama Care or theAffordable Care Act is one of the recent legal measures taken by thegovernment to contain the cost, improve the quality, and enhanceaccessibility of health care services. This program pursues similarobjectives to the managed care program, but avoids the drawbacks(such as inequality and social disparity), which were experienced inearly programs. Obama Care Act eliminated the effect of the dollar aswell as the lifetime limits, which means that Americans can now haveaccess to health care service as long as they need it (Obama Carefacts, 2013) 16.This means that all patients will get important health care services(such as emergency services, laboratory services, prescription drugs,and pediatric care) depending on their health conditions and not onthe dollar limit. In addition, the Obama Care Act emphasizes on theneed to ensure that patients have access to primary care, which willreduce the cost of treating chronic illnesses. In essence, the ObamaCare act is a complementary measure that enhances the achievement ofthe objectives of managed care plans, including the reduction of costand improvement of quality of health care services.

Impactof managed care on nursingImpacton nursing practice in clinical setting

Theintroduction of managed care plans had direct impacts on the dailypractices of nurses. There are three ways in which the managed careplans changed the way nurses carry out their day-to-day practices inclinical setting. First, the health care providers are currentlyrequired to assess the appropriateness of any health services toensure that they only give services that cannot be avoided. Thefounding policies of the managed care plans emphasize on theimportance of avoiding unnecessary treatment and diagnosticprocedures with the objective reducing the cost of health (Nicholas,2009) 17.For example, financial benefits given to physicians who are able toreduce the duration of hospitalization induce providers to be carefulin assessing the suitability of all the therapeutic procedures in alltreatment cases.

Secondly,the introduction of managed care plans required that the nurses aswell as other health care providers should follow certain treatmentguidelines in making decisions with regard to the suitability ofhealth care services for their clients. Although this might seem toreduce the freedom of nurses to use their knowledge and experience,it ensures that nurses optimize the therapeutic procedures by makingthe best treatment options in each case.

Third,the managed care program recommends that nurses should be subjectedto utilization review in their clinical practices. This means thatnurses would be subjected to external referees to whom they shouldreveal their plans and actions to show the adequacy of the treatment.This enhances accountability as well as responsibility on part of thenursing practitioners. The review requirements induce the nurses toexecute their duties with care bearing in mind that individuals withhigher authority will evaluate their therapeutic decisions.

Impacton education of future nurses

Changesin policy and legal requirements following the introduction of themanaged care plans created the necessity for adjustments in thetraining of the future nurses. These changes were made to ensure thatthe health care professionals comply with the provisions of themanaged care program and enhance its implementation for the benefitof the society. The introduction of managed care as well asmechanisms of risk-based contracting resulted in a shift from acuteoriented care that is characterized with episodic care to caremanaged program that is characterized by population-based outcome.This means that the managed care program focuses on the wellbeing ofthe entire population compared to earlier programs. Consequently,nursing professionals are required to have some understanding ofmethods that focus on quality improvement, lowering the cost, andresponding to the complexity in the clinical context in order toensure the health care system address the needs of the entirepopulation. These expectations are being met through educationalreforms to ensure that future nurses are equipped with knowledge andskills in different fields, including clinical biostatistics,clinical epidemiology, and behavioral science. In addition, the shiftof the nursing practice necessitated the integration of managementtechniques for organizational as well as patient care into nursingcurriculum. Moreover, these changes led to the introduction of newbranches of nursing discipline such as the managed care nursing(Heller, Oros &amp Durney-Crowley, 2013) 18.

Impacton continuing education of licensed nurses

Priorto the introduction of the managed care plans, curriculum of thelicensed nursing focused on acute and episodic care, which means thatthe licensed nurses provided care to patients for particular problemswithout the on-going relationship with their clients (Heller, Oros &ampDurney-Crowley, 2013) 19.This presented the challenge of implementing the managed care programthat focused on preventive care and established relationship betweenthe health care providers and their clients to ensure that thetreatment procedure is optimized. Consequently, different educationalprograms have been prepared by institutions of higher learning toacquaint the licensed nurses with skills in managed care and be atpar with graduating nurses who are equipped with these skills. Someof the skills that licensed nurses obtain by continuing theireducation include roles of nurses in the implementation of themanaged care programs, activities that enhance quality and reduce thecost of health care, the effects of health informatics in health careunder the managed care program among other skills. This means thatcontinuing education among the licensed nurse aims at enhancing theirability to comply with provisions of the managed care program.

Impacton nursing research

Researchis an important factor that contributed towards the effectiveness ofnurses because it provides them with scientifically proven evidenceof their practice. Major reforms in the health sector affect alldisciplines in the field, because all of them should comply with theprovisions of those reforms. Similarly, the introduction of managedcare programs had significant impacts on nursing research becauseresearch findings had to address issues of a population-based care,including the quality, accessibility, and quality of care. Forexample, most of the recent studies conducted in the field of nursingare based on health behavior, disease prevention using primary care,improved client’s experience, and enhanced treatment outcome(Heller, Oros &amp Durney-Crowley, 2013) 20.In addition, the focus of nursing research on population-based carehas resulted in an increase in the number of research works on healthand well-being of communities. All these research works aim atenhancing the quality of health care while minimizing the cost ofproviding the health care services, which are the key pillars of themanaged care programs.

Impacton nursing administration

Themanaged care program had significant effects on the administration ofnursing practice because it increased the government’sparticipation in therapeutic decisions. The government’sintervention was intended to resolve the conflict of interest betweenthe health care providers and patients. For example, the interest ofpeople seeking for health care services include the quality of careand cost while health care facilities focus on their economicsurvival (Heller, Oros &amp Durney-Crowley, 2013) 21.The conflict between the two parties necessitates the governmentinterventions through policy and legal measures to ensure fairnessfor all the stakeholders in the health sector. The managed careprogram is one of the government’s interventions that impacted theadministration of the nursing practice in two major ways. First, thetrend of a persistent increase in the cost of health care servicesresulted in the creation of government regulations, thus reducing therole of administrators of nursing practice to determine the cost ofhealth. This means that the managed care program shifted the duty ofdetermining and regulating the cost of health to other bodies otherthan the administrators of health care facilities. Secondly, themanaged care program enhanced the sharing of responsibilities ofestablished bodies (such as Medicaid program), which increased therole of government oversight in health care services. This means thatthe government took the responsibility of defining, assessing, andmeasuring the quality while enforcing accountability among themanaged care organizations. In addition, ethical aspects of thenursing practice that are limited by economic incentives aredetermined by the government agencies and state policy makers and notby the nursing administrators since the introduction of managed careprogram.

and conclusion

Overthe years, the number of registered beneficiaries of the managed careplans has been increasing since the introduction of the program. Themain objectives of the managed care program were to contain theescalating cost of health care and enhance the quality of care. However, the idea of using the managed care program as a means ofcountering the increase in the cost of health care was received withmixed minds.

Mostof the people of the United States feel that the managed care programwas one of the most effective strategies formulated by the governmentto protect them from the financial exploitation by health careproviders and reducing the overall government expenditure on health.Those who are for this idea support their views in three ways. First,the medical expenditure can be minimized by reducing the use ofhealth care services, which can be achieved by avoiding allunnecessary therapies. Secondly, the cost can be contained byoptimizing the treatment process in order to reduce diseaseprogression to chronic stages that are expensive to treat. Third,enhanced access to preventive health care can reduce the occurrenceof disease and ensure that they are diagnosed in time to reduce theirprogression to critical stages.

Althoughmost of the Americans feel that managed care program was effective inreducing the cost of health, there are a few of them who feel thatthe program was either neutral of increased the cost of care insteadof reducing it. This argument is defended by the opinion that themanaged care functioned by shifting people from existing programs tomanaged care plans, which resulted in a neutral effect on the cost ofhealth care. The neutral effect could have also been caused by thefact that the fee for service program had already been set at aminimum prior to the introduction of the managed care program. Inaddition, other people feel that the key objectives of the program(quality and overall government expenditure) were not addressed bythe program.

Themanaged care program impacted the field of nursing in four ways,which including the change in ways nurses conduct their dailyoperations, change of education program for the future nurses inorder to acquaint them with skills for the managed care program,continuing education for the registered nurses to enhance theirability to implement the program, ensuring that the nursing researchfocus on disease prevention, and increase in government participationin the management of health care sector.

Inconclusion, the managed care program was a successful strategy thatcontained the trend of continuous increase in the cost of health careservices in the United States. Although there are many possiblecauses of this effect, two of them are more significant. First,enhancing accessibility of preventive care reduced the cost oftreating chronic diseases. Secondly, improvement in the quality ofhealth and effective services utilization are effective measures toreduce the medical cost.


Thepresent study was accomplished by reviewing both secondary andprimary sources that addressed the issue of escalating cost of healthcare. Although there are many research works addressing the topic ofescalating cost of health, it was a challenge to select the mostrelevant sources given the fact that the present topic was broad.This is because the paper covered both sides of a highlycontroversial issue of persistent increase in the cost of healthcare. In addition, getting more recent (less than five years sincetheir publication) scholarly articles was a challenge.

Despitethe large number of challenges faced during the literature review, itwas an opportunity to review one of the highly debated issue, whichhas direct impacts on almost all people if not everyone. Thisprovided an opportunity to evaluate the opinion of both the opponentsand proponents of the issue of the rapid increase in the cost ofhealth. Additionally, the articles reviewed in the present studyobjectively addressed the government’s intervention through themanaged care plan and the impact of the government’s involvement.

Itwould be advisable to address the issue of escalating cost of healthin a narrow perspective in the future. For example, a single studycan address the effect of reduced service use on the cost of healthcare and another study to address other topics such as the effect ofoptimized treatment process, which is enhanced by the managed careprogram. Focusing on specific aspects will enhance the capacity ofthe researchers interested in this topic to come up with conclusiveand more convincing evidence of the impact of managed care to containthe escalating cost of health care.


1.Duggan and Hayford (2011) studied trends of the increase inenrollment in managed care plans and identified that the rate hasgone up by 70 % since the start of the program.

2.See Shoemarker, Pozniak, Subramania &amp Mauch (2010) four differentplans under the managed care program.

3.Nicholas (2009) provides an insightful assessment of the relationshipbetween the quality and the cost of health care.

4.Ibid, p. 8 establishes the relationship between reduced service useand lowering the cost of health.

5.See Felder (2013) for the effectiveness of utilization reviews underthe managed care program in reducing the cost of health.

6.Sparer (2012) gives an example of how access to preventive healthcare reduced the cost of care and resulted in savings of 3.8 in Iowa.

7.Felder (2013, p. 15) describes how optimization of the treatmentprocess can help in reducing the cost of health.

8.Rossiter, L. (2009) provides a detailed analysis of how preventivehealth care can reduce disease progression to chronic levels, thusreducing the cost of treating severe illnesses.

9.See Duggan &amp Hayford (2011) for variations in the impact of themanaged care plans between states where the plans increased savingsin a few states and increased the government expenditure on health inother states between 1991 and 2003.

10.Duggan and Hayford (2011) suggest that the health care facilities areable to reduce the cost of health by negotiating rate ofreimbursement with insurers. However, this is not possible under themanaged care programs.

11.Ibid,9 identified that the managed care programs over-emphasized onprimary care while reducing the importance of emergency care andinpatient services, which are necessary for patients’ recovery.

12.Sparer (2012, p. 12) demonstrates how the similarity between thebasic principles of the managed care plans and prior health careprograms (such as the fee-for service) and the managed health careprogram reduced its impact on the cost of health.

13.Graham, Kurtovich, Ivey &amp Neuhauser (2011) discuss how themanaged care program failed to address the issue of accessibility topreventive care among the vulnerable members of the society, thusfailing to reduce the cost of health among this population.

14.Although the managed care programs increased the government savingson total medical expenditure, Duggan and Hayford (2011) identifiedthat the cost of treatment per patient has been increasingconsistently.

15.Although opponents of the managed care plans argue that they do notenhance the quality of health care services, McCue and Bailit (2011)identified that the level of quality achieved differs among thepublicly traded and plans and those that are not publicly traded.

16.Obama Care facts (2013) demonstrate how Obama Care Act supports themanaged care program by reducing the cost of health care throughpreventive care and enhancing the quality of health care services.

17.Nicholas (2009, p. 8) explained how the managed care program changedthe nursing practice, especially following the introduction ofpredetermined treatment guidelines in making the treatment decisions.

18.Heller, Oros &amp Durney-Crowley (2013) provides a discussion of howthe introduction of the managed care program created the need forreforming the nursing education programs to acquitting the futurenurses with skills required for the implementation of the program.

19.Ibid, 1 shows how the introduction of the managed care programnecessitated further learning among the licensed nurses in order toenhance their capacity for the implementation of the program.

20.Ibid, 1 provides the analysis of how the managed care programresulted in a significant shift towards the population basedtreatment.

21.Ibid, 1 identified that the managed care program increased thegovernment intervention to reduce the conflicts of interest betweenthe health care providers and their clients, which led to escalationin the cost of health care services.



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