Discuss the meaning of the following statement about the negative aspect of managed care: Healthcare is over-managed and under led.

Discuss the meaning of the following statement about the negative aspect of managed care: Healthcare is over-managed and under led.

Discuss the meaning of the following statement about the negative aspect of managed care: Healthcare is over-managed and under led. What can nursing leaders do to improve healthcare so that it is not over-managed and under led?

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THE SCENARIO

As a nurse manager, you are faced with scheduling the staff for the Thanksgiving, Christmas, and New Year’s holidays. The unit has no policy, and this scheduling has always been a nightmare that everyone has somehow lived through. There are 35 RNs and 10 UAPs (unlicensed assistive personnel). You expect a full census, and there is no option for closing beds.

THE QUESTION

How do you determine if it is a fair and equitable division of time off for all staff?

Solution Preview

Introduction

The term “managed care” or “managed healthcare” is used in the United States to describe a group of activities ostensibly intended to reduce the cost of providing for profit health care while improving the quality of that care (“managed care techniques”). It has become the essentially exclusive system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010. …intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.^[1] The growth of managed care in the U.S. was spurred by the enactment of the Health Maintenance Organization Act of 1973. While managed care techniques were pioneered by health maintenance organizations, they are now used by a variety of ………………….