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 that are deemed *****ly unnecessary, are not approved by the organization, or are provided ***** health c***** 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 ***** health care provision have been in response to a new demand f***** 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 in ***** 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 year in the clos*****g 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 ***** on the individual can be devastating, ***** long-***** ***** 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, by definition, the term "chronic" refers to a long-term medical problem; while a number of tre*****tments are available for ***** types of ***** diseases, in some cases, treatment is ***** effective or the patient's ***** has deteriorated past the "po*****t of no return."

Background and Overview

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

The ***** "capitation" ***** to the provision of an agreed-upon set of services delivered for a prepaid fee, regardless of the amount of ***** used. There*****e, for a specified rate, "per member, per month," health mainten*****ce ***** (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 serving ***** with chronic or high-cost health problems within such a budget (***** 297).

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


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