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 ***** health care professionals outside the *****'s network. ***** ***** 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, c*****porate 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, according to Vic*****ria McGovern essay, "Lung Disease a Drain on Coffers," health care costs for Americans with chr*****ic respiratory diseases amounted more than $45 billion a ye*****r in the closing years of the 20th century, and the incidence of many types of respiratory ***** is once again on the rise (***** 2004:454)

While the effects ***** the various respiratory diseases on the individual can be devastating, the 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 ***** long the condition may pers*****t. Unfortunately, by definition, the term "chronic" refers to a ***** medical problem; while a num*****r of treatments are available for ***** types ***** respiratory diseases, in some cases, treatment is not effective or the patient's condition has deteriorated past the "po*****t of no return."

Background and Overview

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

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


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