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 medically unnecessary, are not approved by the organization, or are provided ***** health care professionals outside the organization'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 provision have been in response to a new demand for 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 ***** ***** 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 Victoria McGovern essay, "Lung Disease a Dr*****in on Coffers," health care costs for Americans w*****h chronic respiratory *****s amounted more than $45 billion a year in the clos*****g years of the 20th century, and the incidence ***** many types of respiratory diseases is once again on the rise (***** 2004:454)

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

Background and Overview

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

***** ***** "capitation" ***** 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 mainten*****ce ***** (HMOs) cover ***** health care of their subscribers and are "at risk" if service use exceeds the budgeted amount they ***** received. Concerns about capitation frequently focus on the incentive ***** underserve clients and the challenges involved in adequately serv*****g people with chronic or high-cost health problems ********** such a budget (Strom-Gottfried 297).

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


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