Essay - Disease Management of Chronic Respiratory Disorders: Economic Benefits for Corporations...

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Disease Management of Chronic Respiratory Disorders: Economic Benefits for Corporations and Managed Health Care

Executive Summary

Generally speaking, the term "managed care" refers to a variety of systems of medical ***** delivery in which patients' use of health services is controlled by organizations that may deny payment for services ***** are deemed medically unnecessary, are not approved ***** the organization, or are provided by ***** c***** professionals outside the organization's network. ***** care organizations usually employ financing innovations that contain costs ***** reducing provider reimbursements or limiting the average expenditure per enrollee. These approaches ***** health care provision have been in response to a new demand ***** increased economic efficiency, market competition, and, most controversially, c*****porate profit taking in the *****care marketplace (Portz, Reidy & Rochefort 1999).

Improved living conditions in recent decades have resulted in a reduction in ***** incidence of respiratory diseases; for example, respiratory disease was three times higher among Civil War veterans than it is in elderly people today (Cutler 2004:6); however, accord*****g to Vic*****ria McGovern essay, "Lung Disease a Dr*****in on Coffers," health care costs for Americans w*****h chr*****ic respiratory diseases amounted more than $45 billion a ye*****r in the closing years of the 20th century, and the incidence of many types of respiratory diseases is once again on the rise (McGovern 2004:454)

While the effects ***** ***** various respiratory ***** on the individual can be devastating, ***** long-term costs associated with treating chronic respiratory ***** ***** also be staggering, ***** it is vital that effective alternatives are available for providing these individuals with appropriate treatments for ***** long the condition may persist. Unfortunately, by definition, the term "chronic" refers to a ********** medical problem; while a number of tre*****tments are ***** for many types of respiratory diseases, in some cases, treatment is ***** effective or ***** patient's condition has deteriorated past the "po*****t of no return."

Background and Overview

***** Health *****. The term "managed c*****" usually refers to many different strategies that are employed alone or in ***** comb*****ations in such a way as to literally manage care and thus control ***** costs of ***** ***** other services; some commonly used *****, and those ***** frequently linked ***** ethical concerns, include capitated payment *****, gatekeeping ef*****ts, quality assurance mechan*****ms, ***** ***** and consumer incentives (Strom-Gottfried 1998:297).

***** ***** "capitation" refers to the provision of an agreed-upon set of services delivered for a prepaid fee, regardless of the amount of services *****. Therefore, for a specified rate, "per member, ***** month," health mainten*****ce organizations (HMOs) cover the ***** care ***** their subscribers and are "at risk" if service use exceeds the budgeted amount they ***** received. Concerns about ***** frequently focus on the incentive to underserve clients and the challenges involved in adequately serving ***** with chronic or high-cost health problems within such a budget (***** 297).

***** strategies provided under managed care programs typically include requiring preapproval ***** services ***** screening by a primary care physician prior to referral for tests or a


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