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

***** 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 Vic*****ria McGovern essay, "Lung Disease a Drain on Coffers," health care costs for Americans with chr*****ic respiratory ********** amounted more than $45 billion a year in ***** closing years of the 20th century, and the incidence ***** 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 chronic respiratory ***** can also be staggering, ***** it is vital that effective alternatives are available for providing these individuals with appropriate treatments for however long the condition may persist. Un*****tunately, by definition, the term "chronic" refers to a ***** medical problem; while a number of tre*****tments are ***** for ***** types of respiratory diseases, in some cases, treatment is ***** effective or ***** patient's ***** has deteriorated past the "point of no return."

Background and Overview

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

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

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


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