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 by the organization, or are provided ***** ***** care professionals outside the *****'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 dem*****nd ***** 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 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, accord*****g to Vic*****ria McGovern essay, "Lung Disease a Dr*****in on Coffers," health care costs for Americans with chronic 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 ***** is once again on the rise (McGovern 2004:454)

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

Background and Overview

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

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

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


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