Discuss the role of managed care in health promotion and disease prevention in the United States.

Question

What will be an ideal response?

Answer 1

• With the arrival of capitated HMO insurance plans, the opportunity for organized health promotion and disease prevention has appeared. In a capitated HMO organization, three important principles apply:
(1) A specific physician or group of physicians have the responsibility of providing an entire package of health services to an enrolled population over a period of time; this means that responsibility for the overall health status of an enrolled population can be specifically identified and evaluated. Previously, it was difficult to identify exactly which physician or groups of physicians might be responsible for a particular subpopulation’s health outcomes.
(2) The responsible physician or medical group is paid on a per capita basis, not for each item of service. This type of health plan emphasizes a long-term overall responsibility for total health, not just a short-term responsibility for the provision of an individual health service.
(3) In return for the continuous payment of capitated fees to a physician or medical group, the health plan can require the physician and group to meet certain standards of care (including the provision of preventive services) and can require routine collection of service data that proves the preventive services are actually being delivered.
With these three principles, HMO-type managed care has the potential to play an important role in health promotion and disease prevention in the private sector.