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 ***** ***** c***** professionals outside the organization's network. Managed *****are organizations usually employ financing innovations that contain costs by reducing provider reimbursements or limiting the average expenditure per enrollee. These approaches ***** health care prov*****ion 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 ***** 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 w*****h chronic respiratory diseases amounted more than $45 billion a year in the closing years of the 20th century, and the incidence of many types of respiratory diseases is once again on the rise (McGovern 2004:*****4)

While the effects ***** ***** various respiratory diseases ***** the individual can be devastating, ***** long-***** ***** associated with treating chronic respiratory conditions ***** also be staggering, and it is vital that effective alternatives are available for providing these individuals with appropriate treatments for however long the condition may persist. Un*****tunately, ***** definition, the term "chronic" refers to a long-term medical problem; while a number of treatments are ***** for many types ***** respiratory *****, in some cases, treatment is ***** effective or ***** patient's condition has deteriorated past the "po*****t of no return."

Background and Overview

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

The ***** "capitation" refers to the provision of an agreed-upon set of services delivered for a prepaid fee, regardless of the amount of ***** used. Therefore, for a specified rate, "per member, ***** month," health maintenance organizations (HMOs) cover the ***** care ***** their subscribers and are "at risk" if service use exceeds the budgeted amount they ***** 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).

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


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