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 care delivery in which patients' use of health services is controlled by organizations that may deny payment for services ***** are deemed *****ly unnecessary, are not approved ***** the organization, or are provided by ***** care professionals outside the organization's network. ***** ***** 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 for increased economic efficiency, market competition, and, most controversially, corporate profit taking in ***** *****care 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, according to Victoria McGovern essay, "Lung Disease a Drain on C*****fers," health care costs for Americans with chronic respiratory *****s amounted more than $45 billion a ye*****r in ***** closing years of the 20th century, and the incidence of many types of respiratory diseases is once again on the rise (***** 2004:454)

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

Background and Overview

Managed Health C*****. The term "managed care" usually refers ***** many different strategies that are *****ed alone or in ***** combinations in such a way as to literally manage ***** ***** thus control the costs of health and other services; some commonly ********** *****, and those ***** frequently linked ***** ethical c*****rns, include capitated payment systems, gatekeeping efforts, quality assurance mechan*****ms, ***** 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. There*****e, for a specified rate, "per member, per month," health mainten*****ce ***** (HMOs) cover the ***** c***** of their subscribers and are "at risk" if service use exceeds the budgeted amount they ***** received. *****oncerns about ***** frequently focus on the incentive ***** underserve clients and the challenges involved in adequately serving people with ***** or high-cost health problems within such a budget (Strom-Gottfried 297).

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


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