Discussion Week 1

Question 1

In certain situations managed health care offers the most effective solution. For example when a patient needs surgery, this program may offer cost savings. Surgeries are usually expensive due to their technicality, risky nature and lots of commitment on the part of the physician. Managed care ensures that the patient pays a lower cost as it establishes cost sharing incentives for outpatient surgery. The major benefit is that of obtaining quality service at a reduced cost. Similarly, there is improved care for patients with complicated conditions.

Question 2

Case management refers to a tool for offering services to those with chronic medical conditions, this includes cost effective telephone interventions to monitor medical services or offer planning to inpatient facilities. A scenario in which effective case management is used is in the mental health where case management helps a client to receive disability benefits or housing assistance.

The benefits of this program are integrating services to the needs of individuals with long term problems for example mental patients. Other benefits arise from the fact that its pro- active and community based. In addition, case management reduces the utilization of hospital based services.

Question 3

In some cases, case management is said to be done poorly for example in the case that the health and well being of the carer is compromised. Scenarios where the carer contracts the chronic disease like tuberculosis, HIV or is abused by the patient, case management is said to have been done poorly.

Question 4

I would manage these circumstances by assessment of the cases, care planning and care coordination to ensure that case management is effective. This will reduce cases where the carer well being is compromised and will increase quality of care.

References:

Ross, S., Curry, N., & Goodwin, N. (2011). Case Management: What it is and how it can best be implemented. King's Fund.

Scott, W. R. (2000). Institutional change and healthcare organizations: From professional dominance to managed care. University of Chicago Press.

Miller, R. H., & Luft, H. S. (1997). Does managed care lead to better or worse quality of care?. Health affairs, 16(5), 7-25.