Some healthier people. Until the 1980s, mental
Some researchers feel that our society has unrealistically demanded the health care system to maximize quality while lowering the costs of health care services.
That if we demand this change, there is no way we are realistically considering the cost of health care. I understand that everyone wants to receive the best therapy without paying a large amount of money. When you think about this idea, this plan would take time to execute. One of the cons of living in a country like the United States is that we citizens expect to have things right when we want them.
I totally agree that we deserve the best services at the lowest prices. But how should we go about executing this plan? We will have to balance the plan between two approaches, the fee-for-service care and managed care. As well as their similarities and differences, these health care styles have their up and their downs. So to make the American people happy, we would have to find an intersection that could increase the quality given and the lower the cost being paid by the client.We, as citizens, should be entitled to these conditions because many people cannot afford these therapy sessions that are terribly needed.
By finding this meeting ground, we will set the stage for a better health care system and possibly a healthier people. Until the 1980s, mental health services were generally purchased under traditional fee-for-service approach. In this way, practitioners controlled both the supply and the demand sizes of service delivery (Cummings, 1995). The practitioners would determine what the client needed, how and when to treat them, and how long therapy would last.Individual practitioners billed insurance carriers on a fee-for-service basis, and there was little encouragement for practitioners to reduce costs by increasing their efficiency and effectiveness. The numbers of healthcare professionals entering the marketplace was large, so the general idea was that fees would plummet.
Contrarily, the complete opposite has been the case, and the fees have risen. The costs were rapidly mounting, especially in inpatient care. This caused third-party payers to demand more effective costs and quality controls (Acuff et al. , 1999).Under fee-for-service care, some therapists may operate from the idea, “the longer the better”.
To think that this system is not abused would be naive. The solution to this ordeal was managed care. Managed care stressed time-limited interventions, cost-effective methods, and focused on preventive rather than curative strategies. This style was easy to sell to businesses because it offered a plan that would control the increasing costs of health care.
When mental health professionals failed to control rising costs of health care services, it helped develop managed care (Karon, 1995).Only a small number of people can afford the fees for psychological services. As the nation changes from fee-for-service toward managed care, as well as quality and cost, there are other issues that grab attention. Managed care is driven by economics, like any other business. Invalid are health care professionals’ attitudes that the chase of profit has no place in the effective delivery of psychological services.
Current managed practice is branded more by an interest in reducing costs than by quality of service (Davis & Meier, 2001).Managed mental health care has considerably affected the counseling profession. The social environment that health care providers have to make trade-offs in between quality and costs could not be more aggressive. Ever since the 1940s, people have held on to the idea that costs should not play a role in decisions about medical treatments (Eddy, 1997). Today there is a solid distaste against clearly taking cost into consideration when choosing the appropriate use of a treatment. This unmentionable aspect places a major limit on how any type of system can trade off cost and quality.
The cost taboo is the result of two especially important factors. The first is the health care deals. Health care deals with the ultimate issues on human existence: life, death, peace, suffering and function. The dire importance of these ideas of health argue for sparing no effort, and no cost, in trying to achieve the best possible outcomes (Eddy, 1997). Secondly, are insurance, prepayment, and taxes, which are all devices our society had created for increasing the costs of healthcare. Many of the people who receive the care are not paying the costs.
So, it is very easy for them to proclaim that the care they receive should not have a limit by any determination of costs. Sixty years ago, people did not have this problem, because everyone was obligated for his or her own bills (Eddy, 1997). Space prevents a full breakdown of the differences between fee-for-service and managed care. There are important characteristics of each that affect how trade-offs between quality and cost are made. For fee-for-service: There is no “defined population” for which the insurance company is responsible.
Connections with the system are initiated by the patients.The main focus is on treating sick patients. Neither physicians nor insurance companies are responsible for providing care beyond what is specified when patients seek care (Eddy, 1997).
The responsibility of the insurance company is to pay the bills. Importantly, the insurance company is not responsible for the overall health of its subscribers or for the quality of care delivered by individual physicians. Physicians are left to decide what care their patients should receive. Physicians have a financial encouragement to overuse care, when there is hesitation about the appropriate level of care.The insurance company had no decision-making control over the providers, and there is no ability for unified decision making. The differences of the conflict between quality and cost are split: Physicians have income incentives to maximize the services they deliver to patients, while administrators have market incentives to keep premiums low (Eddy, 1997). Characteristics of managed care that affect the cost/quality trade-off include the following: The managed care organization has responsibility for the health of a defined population: all of the people who paid dues.
For this “defined population”, the MCO is responsible for the entire spectrum of care, ranging from primary prevention to screening, diagnosis, treatment, rehabilitation, and support care. The contacts are initiated not only by the patients, but by the organization. Physicians are not left alone to practice as they see fit. The MCO has a variety of clinical management systems for managing the actions of physicians.
The MCO has a capacity for centralized decision making. The medical director feels the pressures both to improve quality and to reduce costs (Eddy, 1997).There are ethical principles in almost everything we do.
Some of the ethical principles that apply to tradeoffs between cost and quality include fairness, equality, and optimality. In terms of fairness, if a group of people are making the same input to a pool of resources from which the costs of treatment will be made, they should all expect to receive the same treatment (Cooper & Gottlieb, 2000). Equality refers to people receiving the same treatment regardless of any circumstances.
If they are paying for the same treatment, one person should not get second-rate care. That is a waste of their money if they are not going to get equal treatment. Optimality is referring to the fact that the treatments that the patient receives should be for the best health outcome. Even though there is a general impression that costs should not play a role in medical decision making, this is not and has never been the case, even in traditional fee-for-service medicine. There have always been tradeoffs between costs and quality. They have just been implicit.Instead of talking about costs, we’ve talked about “practicality” and “prudence”, when they are all the same thing (Eddy, 1997).
We have tried to cover up talking about cost by using other words. If we are going to other words that meant he exact same thing, we should just be up front about the situation at hand and stop beating around the bush. This is peoples’ lives and money that are being played with. Traditional fee-for-service has been rationed care all along. It is a shame that we can ration off the healthcare to whomever we feel we want to have it.What about the other people who deserve and pay for the same treatment. What is the use of making people pay for this care if they are not going to benefit from it as equally as the next person? Our healthcare system is corrupt.
Current national guidelines from the National Cholesterol Education Program call for treatment with drug if, after a trial diet, a person’s low density lipoprotein cholesterol exceeds 190 mg/dL (Eddy, 1997). This reliable evidence that people who have lower LDL-cholesterol levels would also benefit.They should if they have the same condition that fits the treatment. There is no ethical reason these people cannot receive the fair treatment they deserve. They do no recommend everyone who would possibly benefit because that would grossly increase the number of persons to be treated. It would be impractical, because it would cost too much. It should not matter how much it cost if they have already paid for it.
It is as if people are taking other people’s lives and fate into their own hands and it is the farthest thing from what needs to be done.The fact is that wherever there is any threshold or any other decision variable that determines who should receive treatment and who should not. There is someone in this world that could have benefited, but was deprived of that benefit. If these benefits were extended to everyone it would be too expensive.
No one should take it into their own hands to put a price on someone’s life or wellbeing. If rationing is defined as withholding coverage, because of its cost, for a treatment that is known to be effective, then fee-for-service medicine has always rationed (Eddy, 1997).The most complex ethical issue for managed care involves its responsibility to maximize the overall wealth of its members. It is absolutely impossible to determine how to give resources proficiently to maximize the health of a population within a limited budget without examining the costs of different treatments and without including that information in determinations of what establishes appropriate care.
The most important variants of managed care that affect cost/quality trade-offs involve financial incentives.In the pure form of managed care, physicians are salaried and have no direct financial incentives to either overuse or underuse care. Their only financial incentive is actually an obligation—to do their part to keep total costs within a fixed budget (Eddy, 1997). These inconsistencies can be reduced and eventually eliminated only by explicitly analyzing the evidence for the treatments; estimating the magnitudes of their benefits, harms, and costs; making explicit trade-offs between the benefits and costs; and giving priority to those treatments that have the highest value.In addition, solving these problems will require a removal of financial incentives to either overuse or underuse treatments and more active management of physician behavior.
For managed care to fulfill its commitment to maximize the overall health of its members within the available resources, it will have to do two things: formally incorporate costs in decisions about treatments, and actively manage practices to line them up with the priorities based on the values of different treatments (Eddy, 1997). People’s demand that costs be controlled is serious and understandable.I respect their refusal to pour unlimited personal resources into the pool from which the bills will be paid. For the use of public resources, any ethical principles must accept whatever constraints people place on what they are willing to pay, and the obligation of the providers is to be fair, equal, and optimal within those limits. The ethical goals in regards to the tradeoffs between costs and quality until we get past the cost taboo and incorporate costs formally and implicitly in decisions about treatments.
The bottom line of this situation is that healthcare is being practiced in an environment in which many if not most people are not willing to pay an infinite amount of money to receive a benefit that may be small. The professional societies know the most on this topic and will have to take the lead in making a distinct difference between fee-for-service and managed care. Regardless of who acts, until the cost taboo is broken, the tension between cost and quality, and all the ethical problems that result, will continue to outbreak the practice of medicineReferences Acuff, C. , Bennett, B. E.
, Bricklin, P. M. , Canter, M. B. , & Knapp, S.
J. (1999). Considerations for ethical practice of managed care. Professional Psychology: Research and Practice, 30(6), 563-575. Cooper, C.
C. , & Gottlieb, M. C. (2000). Ethical issues with managed care: challenges facing counseling psychology. The Counseling Psychologist, 28(2), 179-236.
Cummings, N. A. (1995). Impact of managed care on employment and training: a primer for survival.Professional Psychology: Research and Practice, 26(1), 10-15 Davis, S. R.
, & Meier, S. T. (2001). The elements of managed care: a guide for helping professionals.
Belmont, CA: Brooks/Cole, Cengage Learning. Eddy, D. M.
(1997). Balancing cost and quality in fee-for-service versus managed care. Health Affairs, 16(3), 162-173. Karon, B. P.
(1995). Provision of psychotherapy under managed health care: a growing crisis and national nightmare. Professional Psychology: Research and Practice, 26(1), 5-9.