Healthcare Policy and Economics
Student’s Name
Institutional Affiliation
Managed Care
Managed care refers to terminology utilized in the United States of America to explain a series of activities aimed at lowering the cost of offering for-profit healthcare and availing American health insurance while increasing the degree of the quality of the service. Managed care is geared towards reducing the unintended cost of providing health care by the utilization of different kinds of techniques; such techniques may include; economic solutions for medical professionals and the patients in helping them to chose for the cheapest forms of health care; plans for analyzing the importance of medical services; up the beneficiary cost-sharing; monitor the inpatient registration in the hospitals and the time that these patients stay in the hospital; the institutionalization of cost reduction techniques regarding the outpatient surgery; choosing the physicians with the appropriate skills and knowledge; intensive management increased cost of health care numbers (Bird, Reney & Ross, 2015). These plans may apply to different environments such as Health Maintenance Organization and Preferred Provider Organizations. Also, health care is managed by the utilization of the lawsuits, societies that lobby for the rights of the patients sue the providers of health care who may abuse the rights of the worker. This attempt has led to increased provision of quality health care. Furthermore, the utilization analysis technique is used to check whether the charged amount of money is equivalent to the offered service.
Roles of Private Insurer
Privates insurer plays a significant role in ensuring that quality health care gets offered through the establishment of various initiatives. These initiatives’ effectiveness is so substantial that it got support from the government. The initiatives established by the private insurer are several. Firstly, the private insurers have engaged in a program that helps improve the Delivery of Long-Term Care; this initiative ensures that the patients with chronic conditions in various communities get reached, and the required standard of health service is provided (Mulder, 2017). Secondly, Extension of the Use of Telehealth, this initiative is vital to patients as it helps them to utilize the technology in the provision of quality health care. Through this technique, the private insurer provides a variety of options that the patient can use to select a doctor who will treat them at the expense of the private insurer. Thirdly, the private insurer has helped in lobbying for the integration of Behavioral Health and Primary Care. This technique is so useful that it has aided in upping the results of health care with a reduction in the cost of treatment. This means that only a few money on the savings of a patient will be used in seeking medical services. Finally, the private insurers have taken the initiative of hiring the medical professionals who will aid in providing advice to an insured on how to lead meaningful lifestyles to avoid incurring unnecessary costs to cater for the medical services. Generally, it is appropriate to say that the private insurer’s initiatives help in increasing the quality of the healthcare provided to patients.
Roles of Nurses
Nurses play various roles that increase the quality of patient outcomes. Firstly, the nurses demand improved health care quality; whenever this issue gets met, the patients can receive improved health care because specialized doctors and sophisticated machines are employed. Secondly, the nurses through the American Nurses Association always request for enough number of nurses in various hospitals. This attempt means that the nurse will be able to attend to a smaller group of patients; hence he/she will manage to follow up on them to find out how they are faring. Thirdly, the nurses always demand a conducive environment that will enhance the smooth provision of the required service (Wright, Potter & Nattinger, 2016). Some settings on which various hospitals get built are inconducive due to glitches such as air and sound pollution. Finally, the nurses always demand to be given free time to study and do research concerning the provision of improved medical healthcare. The knowledge that these nurses always get up the quality of the service that they provide. It is beyond doubt that the nurses’ roles help in improving the nature of the service that the patients receive.
Strategies used by the Nurses
Nurses use various strategies that can help in advocating for healthcare users and lower the expense of health care. Firstly, the nurses have involved themselves in promoting home-based care affiliated with a controlling technology. This strategy has helped in reducing the number of patients that get admitted to the hospitals. The patients based in various homes are controlled by the nurses in the hospitals to check on their performance. The strategy aims at lowering the cost of admission of the patients in the hospitals. Secondly, the nurses have helped in the automation of repetitive administrative tasks. Through this technique, the nurses avoid visiting all the patients from their beds; instead, they monitor the situations of the patients while on their offices to check out how they are performing (Nickitas, Middaugh & Feeg, 2019). The strategy ensures that the nurses only visit the patients who need their care and avoid wasting time on those who do not need their attention. Finally, the nurses involve themselves in the business of advising the hospitals in reducing burnout and expensive turnover by the adoption of technology. This strategy ensures that a hospital has enough number of nurses that will help in the provision of the services that are required. Also, the idea helps reduce the cost of accessing the limited number of nurses since the nurses will be readily available.
References
Bird, K., Reney, M., & Ross, R. (2015). Funds flow in the era of healthcare transformation. Healthcare Financial Management, 69(12), 42–47.
Mulder, J. (2017). The value of “smart growth” in the era of value-driven care. Health Management Technology, 38(9), 6–7.
Nickitas, D. M., Middaugh, D. J., & Feeg, V. D. (2019). Policy and politics for nurses and other health professions: Advocacy and action. (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers. Read Chapters 9 & 10.
Wright, B., Potter, A. J., & Nattinger, M. C. (2016). Iowa Wavering on Medicaid: From Expansion to Modernization. Journal of Health Politics, Policy & Law, 41(2), 287–300