Managing Health Care

Introduction

Health care is a growing industry, with the demands for competent nurses, doctors, therapists, and caregivers increasing every year. In many countries like Canada and the United States, a huge number of the nurses, nursing assistants, and caregivers, come from outside their borders. There are already thousands of schools overseas that cater to the training of future health care professionals. Most people find these as excellent opportunities to earn more, because of the ever growing need for medical practitioners.

Managing health care is a system that controls the financing and delivery of health services to the members who are enrolled in a particular health care plan. Managing health care is a very good and efficient way of taking care of one’s health with the opinions and instructions of the specialists on the respective fields. It is actually a very good and comprehensive way of protecting the body from diseases and stress breakdown. Managing health care has many goals to achieve for a particular subject, but there are some goals which are equally and generally important and are focused for everyone.

These goals are to ensure that:

• Providers give high quality care in an environment, which manages and controls the cost in an efficient and effective manner.
• The care delivered is medically necessary and appropriate for the patient’s conditions.
• The most appropriate and the most deserving provider render care.
• Care is rendered in the most appropriate and the least restrictive setting.

Some types of managed care plans are discussed later.

In the management of health care, it pays to know the kinds of facilities that are available to accommodate the needs of a family member with a medical condition. Not all medical services are restricted to hospitals anymore, and there are even an increasing number of care facilities that manage their patients in the comforts of the home. Hospitals may be classified into two categories, based on the length of stay of a patient: there are long-term care institutions and short-term hospitals.

Examples of long-term care institutions are homes for the elderly, which are also called nursing homes, and hospices, which have many medical practitioners that are adept at specific fields of medicine to address more specific concerns. Such specific concerns targeted by hospices may be addiction, rehabilitation, mental disorders, and many others.

There are three common types of short-term care hospitals: community hospitals, teaching hospitals, and public hospitals. Community hospitals have about 50 to 500 beds, and are among the usual places where Americans get their medical care. Most of these hospitals are non-profit, and depend on the support of the community to fund their operations. Teaching hospitals are affiliated with medical schools, and these are where doctors take their internship or residency while treating patients. Public hospitals are funded by the state, and may also be affiliated with nursing homes and rehabilitation centres for specific needs of patients.

Health Maintenance Organizations

Health maintenance organizations also called HMO are the ones who enter into the contract with the healthcare providers who may be the doctors, physicians, hospitals and the other healthcare professionals. These contracted providers provide services at the discounted rate to the health plan members in exchange for receiving health plan referrals. Members are required to see only the health providers within the network of HMO if they want to be paid by the HMO. If members see someone other than the Prescribed service providers then they will not be paid from the HMO for the services rendered by the healthcare provider. Members usually chose a primary care physician also known as PCP who provides, arranges, coordinates and authorizes all aspects of the member’s health care.

Preferred Provider Organizations

Preferred Provider Organizations also known as PPO are similar to those of Health Maintenance Organizations to the extent that they also enter into a contract with the service providers like physicians, hospitals and other healthcare professionals. PPOs don’t provide members with the primary care physician rather they provide their members with the financial incentives that are very attractive to the members of the network. These incentives may include lower deductibles, lower co-payments and higher reimbursements. If you see a physician included in the network then you will have to pay less for the visit and if you visit someone not included in the network then the fee that you have to pay will be more than the other one. The members of the PPO don’t have to get a referral to see a specialist they can go there of their own, obviously they have financial incentives to visit the specialist.

Point of Service Plans

Point of Service Plans also known as POS is also called an HMO/PPO hybrid or an “open ended” HMO. The reason behind its name is that the members have to choose each time which service from the HMO or PPO they have to avail for the time being. Like HMO and PPO the POS has a contracted provider. It is not necessary to choose a primary health care physician in the point of service plan but it is highly encouraged by the providers. PSO plans are becoming more and more popular because they offer more flexibility and freedom of choice then other programmers.

At the level of the home, selecting a health care provider for you and your family should be an aspect of concern. Aside from finding the most appropriate and suitable insurance plan to cover for your needs, it is wise to have an assessment of the clinics and hospitals that are near your home. If a family member has a special condition, try to research on facilities that are well-equipped enough to treat the disease. If there is an aged member of the family, you may opt to explore home care or the hiring of a caregiver. If a nursing home is one of your options, be sure to determine the credibility of the institution.
 

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