Question.1126 - After reviewing pages 189-190 in Chapter 9 of the textbook, discuss a personal or family experience that was impacted by managed care. Be sure to post an initial, substantive response by Thursday at 11:59 p.m. MT, and respond to two or more classmates or the instructor with substantive responses by Sunday at 11:59 p.m. MT. A substantive initial post answers the question presented completely and/or asks a thoughtful question pertaining to the topic. Be sure your post is unique.
Answer Below:
I haven't experienced managed care directly myself, but a close family member faced a significant impact due to managed care protocols. My aunt, diagnosed with a chronic illness, relied on a specific medication to manage her condition effectively. However, her MCO changed their formulary, shifting to a different preferred drug within the same therapeutic class. This transition meant my aunt had to switch medications abruptly. The new drug wasn't as effective in managing her symptoms, causing a decline in her health and quality of life. Despite her physician's strong recommendation to continue with the initial medication, the MCO's policy dictated the change due to cost considerations. Navigating this situation was immensely stressful for my family. We attempted to appeal and explore alternatives, but the bureaucratic obstacles and strict rules were overpowering. Ultimately, it took a considerable amount of time and advocacy from her healthcare provider to secure an exception to the formulary regulation, allowing my aunt to revert to her original medication. This experience resonates with the text's mention of managed care plans using various methods to manage healthcare utilization. "Providers agree to discount their regular fees in exchange for the volume of patients the MCO brings them" (Shi & Singh, 2022). These experiences light up the clash between cost-containment measures within managed care and the individual patient's health needs. It underscored the necessity for more flexibility and consideration for patients' unique medical circumstances within the managed care framework. Reference: Shi, L., & Singh, D.A. (2022). Essentials of the U.S. Health Care System (sixth edition). Jones & Bartlett Learning.More Articles From Medicine
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