At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited and may require approval for specialized care. Planning and monitoring activities ensure standardized care at a minimal cost. Insurance companies and health maintenance organizations are changing to managed care systems. A form of managed care system is the national healthcare system. Large "umbrella"organizations would provide all aspects of care and compete for the consumer's business. Consumers, or patients, can choose only among managed care organizations and not individual healthcare providers.
Case management is a method used to coordinate a patient's healthcare to achieve patient wellness and optimum function through advocacy, communication, and education. It is an interdisciplinary process of assessing, planning, facilitating, and advocating for options to meet healthcare needs. Nurses are the case managers who maintain the continuity of care for seriously and chronically ill patients across the settings. The role of the nurse includes monitoring the care provided, making appropriate referrals, and ensuring that the care provided is evidence-based and follows established standards. The main goal of the case management system is to identify specific protocols and timetables for care and treatment in a specified format known as the critical pathway or care map. The care map helps achieve desired patient outcomes within a particular time frame.
Primary healthcare is described as essential healthcare that is globally accessible to individuals and their families in the community through their full participation at a cost the community can afford. The communal cost is based on methods and technology that are realistic, scientifically sound, and socially acceptable. The primary healthcare system brings healthcare as near as possible to people's residence and employment. It was conceptualized initially to decrease illness and death in member countries. Such goals can be achieved by simple, local, inexpensive solutions to health problems, especially when combined with economic and social development.
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