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 *****ly unnecessary, are not approved by the organization, or are provided ***** ***** care professionals outside the organization's network. ***** ***** organizations usually employ financing innovations ***** contain costs by reducing provider reimbursements or limiting the average expenditure per enrollee. These approaches to health care provision have been in response to a new demand for 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, according to Vic*****ria McGovern essay, "Lung Disease a Dr*****in on Coffers," health care costs for Americans with chronic respiratory *****s 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 diseases is once again on the rise (McGovern 2004:454)

While the effects of the various respiratory ***** ***** the individual can be devastating, ***** long-***** ***** associated with treating ***** respiratory ***** ***** also be staggering, ***** it is vital that effective alternatives are available for providing these individuals with appropriate treatments for ***** long the condition may persist. Unfortunately, by definition, the term "chronic" refers to a ********** medical problem; while a number ***** tre*****tments are ***** for many types of ***** diseases, in some cases, treatment is ***** effective or ***** patient's condition has deteriorated past the "point of no return."

Background and Overview

Managed Health *****. 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 ********** strategies, and those most frequently linked to ethical concerns, include capitated payment *****, gatekeeping ef*****ts, quality assurance mechanisms, and ***** and consumer incentives (Strom-Gottfried 1998:297).

***** ***** "capitation" ***** to the ***** 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, ***** month," health mainten*****ce ***** (HMOs) cover ***** ***** c***** 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 ********** ***** a budget (Strom-Gottfried 297).

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


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