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 medically unnecessary, are not approved by the organization, or are provided ***** ***** care professionals outside the ********** network. Managed care organizations usually employ financing innovations that contain costs by reducing provider reimbursements or limiting the average expenditure per enrollee. These approaches to health care prov*****ion have been in response to a new demand for increased economic efficiency, market competition, and, most controversially, corporate 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, according to Victoria McGovern essay, "Lung Disease a Drain on C*****fers," health care costs for Americans with chr*****ic respiratory diseases amounted more than $45 billion a ye*****r in ***** clos*****g 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 of ***** various respiratory diseases ***** the individual can be devastating, the long-***** costs associated with treating chronic 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 pers*****t. Un*****tunately, by definition, the term "chronic" refers to a ********** medical problem; while a num*****r ***** tre*****tments are ***** for ***** types of respira*****ry diseases, in some cases, treatment is not effective or the patient's condition has deteriorated past the "point of no return."

Background and Overview

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

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

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


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