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Managed Care, an imitation of Preventive Medicine.

The bulk of global health today involves curative medicine, an approach where existing conditions are addressed and cured; curative medicine involves treating illness and disease. Another chunk of health care today with growing interest is palliative medicine, where an individual with an illness is cared for to relieve pain, suffering and discomfort. However, when one hears the words preventive medicine (aka preventive care), the first few words and phrases that come to mind include public health, health and wellness, multivitamins and nutrition, vaccinations, exercise, sanitation, healthy living, the list goes on. Now, when one hears the words managed care, not too many words come to mind as a lay man, but someone in the healthcare industry would think of organized health, health insurance, cost saving strategies for health, health care services, secondary prevention in some format, and even medicare/medicaid. The major difference with all of the above is the timing of intervention.

Preventive care consists of ways to prevent and cure potential ill health, disease, or health conditions. It involves planning ahead and being proactive to avoid the absence of wellness. Public health splits preventive care (aka preventive medicine and preventive health) into 3 sub parts, primary prevention, secondary prevention and tertiary prevention.

Primary prevention zeros in on making sure all potential diseases are avoided; this involves the use of vaccines, exercise, clean and safe environment and sanitation, good nutrition, and the intake of antioxidants. Secondary prevention involves mostly diagnosing and identifying potential health issues; mammograms, prostate exams, the use of medicine to prevent the advancement of a disease in it's infancy is found in secondary prevention. Tertiary prevention is truly a reactive measure to an existing condition to avoid permanent damage to organs of the body; this includes rehabilitation and therapy.

Managed care is an approach where an individual's health and wellness is under the supervision of a group of health care providers. It is an insurance system with a defined boundary on the health care providers and services a member could receive. The parties involved in the health and wellness of the insured range from physicians, to hospitals, to specialized acute or long term settings. The managed care model has transitioned from an exclusive organized health system since the early 1980's to a more modern health system with very little limit however. The increase in potential coverage was more so a need to grow the business portfolio of already existing health insurance companies based on market demands. Since managed care attempts to provide the insured all that's needed for their health and wellness, preventive medicine, curative medicine, and palliative care are typically somewhat provided in a true managed care system. As preventive care attempts to provide service before a potential illness, managed care attempts to provide service through prevention, cure, and comfort as needed.

Discussion: Since prevention encompasses vaccines, multivitamins, diagnosis, treatment and therapy, it truly provides services to an individual all through existence. Preventive medicine does what managed care aims to achieve, but invests most on primary prevention. If managed care was developed primarily as a cost saving strategy for health care, then preventive medicine should be mirrored more through its existence. The question to ask is how do we get existing managed care organizations to embrace prevention as the primary way of providing service to its insured? Please discuss.

God Bless,


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