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 that 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 to health care prov*****ion have been in response to a new dem*****nd ***** 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 ***** 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 Dr*****in on C*****fers," health care costs for Americans with chronic respiratory diseases amounted more than $45 billion a ye*****r in the clos*****g years of the 20th century, and the incidence of many types of respiratory ***** is once again on the rise (McGovern 2004:454)

While the effects ***** ***** various respiratory diseases ***** the individual can be devastating, ***** long-***** ***** associated with treating ***** respiratory conditions can 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 number of treatments are available for many types of ***** diseases, in some cases, treatment is not effective or the patient's ***** has deteriorated past ***** "point of no return."

Background ***** Overview

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

***** 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 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 people with chronic or high-cost health problems ********** such a budget (***** 297).

Gatekeeping strategies provided under managed c***** programs typically include requiring preapproval ***** *****s ***** screening ***** a prim*****ry care physician prior to referral for tests or a

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