I believe managed care plans do not provide coverage for the necessary duration of hospital stays. Most managed care plans, particularly HMOs, are run by for-profit companies. These for-profits are constantly looking for ways to cut costs and increase their market share. Managed care plans limit choice of physicians and health care facilities and tightly control both the utilization of services and the amount charged for these services. In many plans, a set fee per person / per month is negotiated between health care purchasers and providers.
This rate is the same no matter how much or how little care a person receives. This can encourage incomplete advice and inadequate treatment, as in the case of the duration of a hospital stay. Most hospital procedures and surgeries, both outpatient and inpatient, require prior approval. Most plans may require that certain procedures and surgeries be done on an outpatient basis in order to be paid for by the plan. Basically, managed care plans cuts the duration of a hospital stay form the usual post-procedure stay period by discharging them home early. For inpatient hospital care, managed care plans often require prior approval to limit the number of days they will pay for your child to stay in the hospital.
Coverage for longer stays requires approval by the managed care plan. (Your Managed Care) If longer stay or duration is needed in a hospital, you will be needed to require lengthy appeals and numerous referrals. Without such approval, you may be responsible for part or all of the hospital and physician charges, thus effectively limiting the length of hospital stay. Not only are patients being pressured / forced into limiting their duration of stay in a hospital, but lately physicians are also facing pressure from managed care plans to lower costs of treatments to gain a bigger profit margin. For example until 1996, doctors were allowing a new mother to stay for as little in a hospital post pregnancy as dictated by managed care plans, until a federal mandate put a minimum and gave new mothers at least 48 hours in the hospital. (Wehrwein 1997) Managed care organizations are offering incentives to doctor changes normal procedures and length of stays to limit expense.
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Procedures that are simpler or require less time, work are done, over more modern better suited for patient procedures. Managed care organizations are primarily worried about controlling costs, and they see that having doctors perform procedures and treatments that require the least amount of hospital stay as more efficient. What develops is physicians are not as free as they once were to decide by themselves what is best for the patient. (Wehrwein 1997) Cost-control mechanisms and capitalization have added lots factors that may end up being detrimental to the overall goal of health care: the best treatment for the patient, regardless of cost. Works Cited How to Use Your Managed Care Plan Effectively: Questions and Answers for Families With Children. American Academy of Pediatrics.
Retrieved July 19, 2005, from web Peter (1997, February).
Why Managed Care Is Getting A Bad Rap. Managed Care Magazine. Retrieved July 19, 2005, from web.
