The History of Health Insurance and Managed Care Health insurance began in the e

Question

The History of Health Insurance and Managed Care Health insurance began in the early part of the twentieth century as a means to protect an organization's assets, either its financial assets or its manpower. Since the early days, health insurance evolved into a system of managed care in order to control issues such as overutilization, skyrocketing costs, limited restrictions, and low-quality care. Using the South University Online library or the Internet, search for articles on health insurance and managed care.

Based on your research, summarize your findings and answer the following questions:

•Examine the main events in the history of health insurance from the mid-twentieth century to the present. Explain how these events led up to the evolution of managed care organizations.

•Evaluate the purpose of health care insurance in the early days.

•Evaluate the evolution of health insurance and managed care. What is the relationship between the two and how has managed care risen to prominence in today's health care market?

•Explain how the perspective of health insurance has or hasn't changed in today's managed care environment.

•Analyze the public policy and market forces leading to the growth of managed care.

•Analyze the current trends in managed care and its future in the context of health care reforms.

Explanation / Answer

Health Insurance and managed health originate from the 20th century. There were a few insurers who offered insurance policies in the 19th century to cover the cost of care for workplace accidents and for employee disability. After few years, few of the insurance policies evolved into coverage for care that was not related to a workplace accident.

History of health care History of Health Insurance and Managed Care Health insurance
There were two different models which provided and paid for health care apart from out-of-pocket. This included early forms which are now known as health maintenance organization. This term was not formed until the early 1970s. The second one included the appearance of the first Blue Cross and Blue Shield plans. The important point of the proto HMO’s was the combination of the functions of insurance and the health care delivery system. The highlight of the early BC and BS plans was the exclusive usage of present hospitals and physicians who practised privately.
The initial example of prepaid medical group practices is included in the western clinic in Tacoma, Washington which was begun in 1910 which provided vast medical services for the premium price of $0.50 per member every month. This was made available to owners and employees of the lumber mill. There was also a program introduced by Dr Bridge who begun his clinic in Tacoma and established 20 sites in Oregon and Washington.
Michael Shahid who was an MD established rural farers’ cooperative health plan in Elk City in Oklahoma in 1929 which was remarkable. The farmers participated in the purchase of shares for $50 each to raise capital for the establishment of new hospital by receiving discounted medical care.
Dr Donald Ross and H Clifford Loos set up a prepaid medical plan for workers at the Los Angeles Department of water and power in 1929 which aimed to focus on physician services and hospitalization along with health maintenance.

Purpose of health care insurance and evolution/changed perspective and current trends

There was opposition to prepaid group practices by the American Medical Association in 1932. During 1937 there was the initiative of the Group Health Association in Washington in 1937 which was a nonprofit consumer cooperative.
1929 also witnessed the beginning of Ross Loos Clinic’s prepaid health plan and Dr Shahid’s rural farmers’ cooperative health plan and Baylor hospital in Texas provided 1500 teachers with prepaid impatient care which were represented as the origins of Blue Cross. This was expanded later on and the new plans received sponsorship by local or regional hospital association which also included member hospitals.
There was also the formation of different BCBS plans in the middle of the Great Depression and several HMOs exhibited the demanding coverage of the consumers or nonphysician entrepreneurs who focused to establish a business and providers wanted to protect and improve the revenues of the patient.
The mid-1940s to Mid 1960s- The expansion begun-
There were inflation and tight labour supply during World Warr II which resulted in the stabilization Act of 1942. There was the continuation of HMO formation slowly and there was the creation of two significant HMOs which still is prominent.
Health Insurance Plan of Greater New York was created in 1944. There was a merge of New York-based Group health incorporated (GHI) to form Emblem Health in 2006.
The consumers in Seattle formed 400 families who made a contribution of $100 to create the Group Health cooperative of Puget Sound.
There was the creation of HMOs during the 1950s which were similar to the independent practice association model in today’s time.
There was also the formation of an important act called the McCarran Ferguson Act which let the insurance companies from federal oversight be exempted.
During the mid 1960s to Mid 1970s, there was an onset of health care cost inflation which was significant.
There was the proposition of an act during the 1960s by John F Kennedy which later became an important part A of Medicare. There were also attempts made to control costs like in 1959 Blue cross of western Pennsylvania, the Allegheny county medical society foundation and the hospital council of western Pennsylvania created anlyses of hospital claims to claim utilization which was above average.
During the 1970s to Mid 1980s, there was an increasing rise in Managed care. The HMP act was passed during 1973 and it led to the authorization of startup grants, loans and ensured access to the insurance market which was based on employers.
There was an increase in HMOs and PPOs which increased with commercial HMO enrollment which grew from 15.1 million in 1984 to 63 million in 1996 according to Jones and Bartlett.
There was costs rise and coverage declines during 2000 to 2010 and peak in HMO commercial enrollment market which increased in 1999 at 104.6 million.
During 2003 there was an increase in the national expenditures as a percent of GDP noticed a high of 15.9%.
The cost of insurance coverage increased with the increase in health care costs and employers paid nearly 70 percent of the cost and the remaining from the deductions of their payroll. During 2010 there was the annual deductible of $1000 or more in half of all small firms and nearly 17 percent of large firms.

There were important contributions made to the delivery systems which were positive and negative. There was an emphasis on presenting as laudable which is currently the law. There was the creation of standard measures like HEDIS and the Consumer assessment of healthcare providers and systems with the public regulatory mistrust of managed health care and health insurers.
There can be a lot achieved by the health plans. It is important for them to be responsive to the desires of the customers and cater to individuals, unions and employers along with the state and federal regulators. There will be and there are ongoing significant contributions made to managed health care according to Blendon and Benson (1998).

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