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

Improved living conditions in recent decades have resulted in a reduction ***** 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, according to Victoria McGovern essay, "Lung Disease a Drain on C*****fers," 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 ***** many types of respiratory diseases is once again on the rise (McGovern 2004:454)

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

Background ***** Overview

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

***** ***** "capitation" refers to the ***** of an agreed-upon set of services delivered for a prepaid fee, regardless of the amount of services *****. There*****e, for a specified rate, "per member, per month," ***** maintenance organizations (HMOs) cover ***** health care ***** 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 serv*****g people with chronic or high-cost ***** problems *****in ***** a budget (Strom-Gottfried 297).

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


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