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 by the organization, or are provided ***** health care professionals outside the organization's network. ***** ***** organizations usually employ financing innovations that contain costs by reducing provider reimbursements or limiting the average expenditure per enrollee. These approaches to health care provision have been in response to a new demand ***** increased economic efficiency, market competition, and, most controversially, c*****porate profit taking in ***** healthcare marketplace (Portz, Reidy & Rochefort 1999).

Improved living conditions in recent decades have resulted in a reduction in the 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 Victoria McGovern essay, "Lung Disease a Drain on Coffers," health care costs for Americans with chr*****ic respiratory *****s amounted more than $45 billion a year in the closing years of the 20th century, and the incidence of many types of respiratory diseases is once again on the rise (***** 2004:*****4)

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

Background and Overview

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

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

G*****tekeeping strategies provided under managed c***** programs typically ***** requiring preapproval for services or screening by a prim*****ry care physician prior to referral for tests or a


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