Access to Care in Managed Care Program

Access to Care in Managed Care Program

Introduction

Access to quality health care is subject to a number of determinant factors that dictate the level of ease with which patients can access quality services. Based from various angles of view, internal and external factors that the health care facilities are subjected to affect the integrity of services offered. Such factors as actual practices, type of facility, density of facility distribution, nature of social forces, funding, compensation, operational costs and location impact on the delivery of health care services. In this discourse, these factors are briefly discussed, compared and contrasted in order to unravel the potency of inherent factors that healthcare faces.

The Factors

Healthcare provider office practices determine the level of success that the actual healthcare given achieves. In the paper titled Capacity Planning and Management in Hospitals, Green (16) notes that the enormity of the issues behind the pressure from cost benefit analysis presses practices to be a one sided affair. The main issues in organization of healthcare institutions include the introduction of competition in the health industry coupled to the reduction of government subsidies. Practices at the healthcare facilities are therefore not only tending towards complete commercialization but also rising cost that the author feels continually impacts in effective reduction in patient access. Without the best approach that is cognizant of modified management tools to fit in the changing health care sector, practices at the facilities will continue to face hardships in achieving appropriate delivery of healthcare.

Alternatively, the types of managed care model in which the providers are involved dictate the manner in which the delivery of healthcare services is conducted. Several models of managed care programs exist with an implication on the fact that the specialized needs of each attract a certain form of operation that would not operate in a different model setting. Health Maintenance Organization (HMO) models include closed panel, staff model, group model, open panel, Independent Practice Association (IPA), network model, and mixed model (TMCI, 2). Each of these models has inherent requirements that uniquely dictate the order of operations and access for health care by individuals. For instance, when dealing with a mental health facility, standard and village settings are differently modeled. The village type has restrictions which may effectively reduce the general access by the public in comparison with the other types of models (TVISA, 1).

Additionally, the concentration of a certain type of health facility in a given physical stretch determines the accessibility of the given service. This is because the geographical density of provider practices directly implies on how well an area is covered by the institution. As partly observed in the explanation given by location of the health facility, coverage of an area by health care centers would also be a factor of their density in an area. Apparently, factors such as the population density of an area determine the appropriate number of health care centers needed. It therefore follows that highly populated regions will require a higher number of health care centers to cater for the large number of patients.

Besides the density factors observed above, perhaps the most important social determinant of distribution of health care facilities and the delivery of health care are the members’ cultural preferences. According to a study conducted by Deogaonkar (1), socio-economic imbalance in the society resulting from multicultural diversity could occasion differential delivery of health care. According to the author, an unequal society is likely to have an unequal delivery of health care due to cultural and identity preference issues. In illustration of social problems related to cultural inequalities for instance in India, the author reckons that cultural setbacks in remote rural areas extend from mere ethnic divisions to gender disparities that exist.

Moreover, amid deliberate attempts for economic stabilization, diminished government funding provides for the cutting of public spending among various sectors which involve health care. The government comes up with health care plans to take care of the health liability of patients in the program. Where there are expectation of compensation available from the public and funding through various packages such as the government, it becomes a big problem for compensation. Funding for health care makes the population more reluctant to meet their health bills. According to AMA (1), licensing of medical institutions is done on the premise that some medical fees are not mandatory from the patients before they are treated. Existence of pre-treatment conditions such as compensation for consultations only makes it difficult for patients to undertake treatment for fear of being unable to meet the cost.

Likewise, health care providers’ costs of operation the health facility as a business seem to be increasing in a hard economic regime marred by uncertainty of the future. When the cost of operating a health care facility goes up, the cost is consequently passed on to the patient who will in return be reluctant t take up health programs. Under the provision of provider training to provide care, there is an element of extra cost since the training figures rise with extra costs. Operational costs are however more potent determinants of healthcare in relation to provision of training which is more specific and seasonal.

Furthermore, expectation of compensation for health care delivered is likely to cause marked response differences from health care providers. In a world full of commercialization in every sector, money is becoming a factor for the determination of what facilities are enjoyed and by which groups and classes. According to Cohen et al (997), it is possible to draw a clear inference that those areas with a poor economic support can have difficulties in attaining medical care. If the population cannot provide compensation for the health care services rendered, it becomes increasingly difficult for them to continue operating. In an industry where operation is controlled by the market system, it is difficult to facilitate the healthcare delivery without a certain element of compensation from the patients.

In addition, issues surrounding access to care by the population that extend to logistics of the facility also determine the delivery of healthcare. According to Daskin and Dean (44), the location of health facilities is strategically considered in the planning stages of the health program. Besides covering the population in as close as possible proximity, it certainly needs a consideration of the condition and maintenance of the facility. Similar sentiments are held by Calvo and Marks (408) in their work where they observe that effective location of the healthcare should be a factor of several factors one of which is a mathematical optimization design.

By comparing all these factors, one common feature is persistent; healthcare is likely to be compromised due to the risks involved. Alternatively, there are several perspectives from which a factor is analyzed from, which gives differential impact; which ultimately affects the status of delivery of health care. It is correct to state that despite the differences in the origin of the factors from both internal and external sources, health care is affected by all factors to varied degrees.

In contrast, while coverage and distribution related factors seem to auger well with economic and funding related factors, social factors seem to have a different impact. Development and planning related factors seem to be both internal and external while social factors appear to emanate from forces beyond the control of the management or donors. In light of this difference, it seems that the healthcare is a factor of both natural and artificial forces that modern healthcare management ought to handle cautiously well.

Works Cited

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Calvo, Alberto B. & Marks, David H. “Location of Health Care Facilities: An Analytical Approach,” Socio-Economic Planning Studies. 7.5(1973):407-422

Cohen, R. D., Kaplan, G., Lynch J. W., & Pamuk, E., “Inequality in Income and Mortality in the United States: Analysis of Mortality and Potential Pathways,” BMJ, 312(1996):996-1103.

Daskin, Mark S. & Dean, Latoya K. “Location of Health Care Facilities,” International Series in Operations Research & Management Science. 70.2(2005):43-76

Deogaonkar, Milind “Socio-Economic Inequality and its Effect on Healthcare Delivery in India: Inequality and Healthcare,” Electronic Journal of Sociology, (2004). Web. HYPERLINK “http://www.sociology.org/content/vol8.1/deogaonkar.html” http://www.sociology.org/content/vol8.1/deogaonkar.html (accessed 11 April 2011)

Green, Linda V. “Capacity Planning and Management in Hospitals,” International Series in Operations Research & Management Science. 70.1(2005):15-41

The Village Integrated Service Agency (TVISA), Comparison of Managed Care Models,” n.d. Web. HYPERLINK “http://www.village-isa.org/Overview/comparison.htm” http://www.village-isa.org/Overview/comparison.htm (accessed 11 April 2011)

Tufts Managed Care Institute (TMCI), “Managed Care Models and Products,” 1998. Web. HYPERLINK “http://www.thci.org/downloads/ModelsProducts.pdf” www.thci.org/downloads/ModelsProducts.pdf (accessed 11 April 2011)