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 medically unnecessary, are not approved ***** the organization, or are provided by ***** care professionals outside the *****'s network. ***** care 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 dem*****nd f***** increased economic efficiency, market competition, and, most controversially, corporate profit taking in the healthcare marketplace (Portz, Reidy & Rochefort 1999).

***** 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 Vic*****ria 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 ye*****r 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 ***** the various respiratory ***** ***** the individual can be devastating, ***** long-***** ***** 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 persist. Un*****tunately, by definition, the term "chronic" refers to a *****term medical problem; while a number of tre*****tments are available for many types ***** respira*****ry diseases, in some cases, treatment is not effective or the patient's condition has deteriorated past the "point of no return."

Background and Overview

Managed Health *****. The term "managed c*****" usually refers to many different strategies that are *****ed alone or in ***** comb*****ations in such a way as to literally manage care and thus control ***** costs of ***** ***** other services; some commonly ********** *****, and those ***** frequently linked to ethical c*****rns, include capitated payment *****, gatekeeping ef*****ts, quality assurance mechanisms, ***** ***** 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, per month," health maintenance ***** (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 ***** underserve clients and the challenges involved in adequately serving people with ***** or high-cost health problems ********** such a budget (***** 297).

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


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