Overview of Managed Care System

, individual clients, groups of business employees or different groups of insured clients, government-related collectives such as people on welfare or medi deal, etc.) for a set monthly pay (the capitation rate). In order to see a profit, HMOs must pop the question their medical services at a cost that is down the stairs the total amount paid by their diverse types of clients.

The IPA consists of a collective of health care providers (e.g. doctors, doctors and nurses, etc.) which: a) provide lower than grocery store value services to individuals and receive reimbursement on a fee-for-service derriere; or b) receive a monthly allotment for nerve managed services plus an additional fee-for-service for any direct care they provide.

In short, managed care dusts tend to be tumid companies or organizations supplying diverse medical services to relatively large collectives of people on a for-profit basis. In this regard, Poplin (1995) has noted that the for-profit taste of managed care systems places a heavy emphasis upon such factors as efficiency, and the provision of those services that foster profit as unconnected to those services associated with loss. The result of this orientation, according to Poplin, is at best, an im individualised system of care and, at worst, low or miserable tone of care.

Most nurses aim at quality care inside the confines of the system for which they work. To upgrade the quality of low/inadequate medical care requires more than merely changing the images or job tasks of nurs

Researcher. In the ability of researcher, the central nervous system is expected to contribute to the existing knowledge sensual of nursing practice using empirical methods and procedures (Pollock, 1987). In other(a) words, the CNS researcher investigates the diverse behaviors associated with nurses fulfilling their occupational and professional role using scientific methods.

es. However, regarding impersonal health care delivery, this is an theater of operations in which nursing can proceed in a strongly remediative role.

Culture Broker. blows in contact with clients from different cultures very much encounter beliefs that appear inconsistent with conventional Western medicine, resulting in the need for the nurse to act as a broker--i.e.

translating and touch on messages, instructions and belief systems from one group to a another. fit in to Tripp-Reimer and Brink (1985), the CNS cannot truly fulfill this role because she or he does not have the education required to come across the perspective of those form cultures other than his or her own. On the other hand, the transcultural nurse is educated to understand these differences and is prepared to function in this role. In this sense, the role of culture broker is laughable to the TNS as it is not really a role that the CNS can function in due to inadequate training.

universe sensitive to the cultural needs of each group as they interface with medical service personnel, equipment, and procedures is an important way in which any health care delivery system, including managed care, can change its contact with clients (Journal of the American Medical Association, November 19, 1995). The need for increasing the personal element or patient-centeredness of the managed health care system is accomplish in the Transcultural Nurse Specialist whose profession is promptly aimed at providing services that are culture sensitive.

Change-Agent. The Clinical Nurse Specialist can function as an initiator and auxiliary of change in a health care
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