Significant Trends/ Issues
In Managed Care
April 11, 2011
Managed care comprises a large variety of arrangements that can combine the functions of health insurance and the actual delivery of care, "where costs and utilization of services are controlled by such methods as gate keeping, case management, and utilization review" (Wishnow-Per, K.. 2010). It is shaped by two major forces, the government and the market. The government imposes rules and regulations that managed care has to comply, and the market dictates strategies that depending on the current time can go from survival to profitable
There is a trend in managed care that has to deal with the Government's recommendation for standards for culturally and linguistically appropriate services (CLAS). It is a response to the changing face of the demographics, market and an effort to establish a public health measure that ensures that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner. The linguistically and appropriate services have already been incorporated as part of the policies for JACHO's accreditation. JACHO stands for The Joint Commission on Accreditation of Healthcare Organizations (JACHO), an independent non-profit organization that had been promoting health policy regulations. Up to 1965 the accreditation was voluntary and obtaining accreditation was seen as a reputable move to show the accredited health care provider was providing the highest possible health care quality services. Things changed when Congress passed the Social Security Amendments of 1965 stating that "hospitals accredited by JCAHO are 'deemed' to be in compliance with most of the Medicare Conditions of Participation for Hospitals and, thus, able to participate in the Medicare and Medicaid programs" (The Joint Commission, 2010 ). The voluntary nature of the accreditation became a must for health...