In this paper I will introduce the topic of capitation in the Health Care System. After a short overview of capitation I would like to address some problems that can arise with its misuse in the system. This problem effects all of us, yet the only disciplines overtly involved in the process of implementation right now are medicine and business (and government if it is not considered business). I will state some of the directions the implementation of capitation in managed care might have us headed hope to address some moral, social and ethical issues that arise when doctors are not paid for quality or quantity, but merely availability. What psychological effects could this have on our drug and dental systems as well as with the emergence and flourishing of the herbal drug market, and what legal consequences could result?
Has anyone noticed that there seems to be a drugstore being built on every corner these days? Revco, Walgreens, and Rite Aid seem to be just a few of the drug store chains that are expanding. One has to wonder if this has anything to do with the possibility of including medicine under coverage by healthcare systems. This means that they may become part of a capitated payment system to the pharmaceutical providers. "By capitation, we mean a prospective payment to physicians or providers - either individually or as a group - of a fixed amount of money to care for each patient (Pearson, 1998)." In other words, every physician is provided a set sum of money whether they see any patients or not and every pharmacy would be given money whether they prescribe any drugs or not. Drug costs will rise.
The question medical groups and IPAs should be asking in the next 10 years is whether they can wisely enter i...
... middle of paper ...
...
As more and more people go without any medical insurance, the time for changes in the healthcare industry seems to be now. The government cries for restructuring and the cost coverage of prescription pills should make us step back and question the broad picture. Why would the public benefit from captitation and which segments of the healthcare industry would benefit from which types of capitation? It is important for the public to be educated on our options, healthcare is something that effects us all, old, young, rich, and poor. Why are medical executives determining the directions of cost utilization in the system and not the public? The only thing that seems to be for ceratain is that further research is vitally needed to clarify how capitation truly effects physician-patient relationships, decision making by physicians, and clinical outcomes.
According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth
Doctors play a major role in society today because doctors will use medicalization to gain power to their name or to their practices and more importantly their income. Another reason why medicalization is apparent in society has also to do with MCOs. MCOs are health insurance providers that restrain costs by monitoring closely the health services given to patients. MCOs either support or oppose medicalization, depending on which tactic best protects their interests (Weitz, 2012,
"In the past two decades or so, health care has been commercialized as never before, and professionalism in medicine seems to be giving way to entrepreneurialism," commented Arnold S. Relman, professor of medicine and social medicine at Harvard Medical School (Wekesser 66). This statement may have a great deal of bearing on reality. The tangled knot of insurers, physicians, drug companies, and hospitals that we call our health system is not as unselfish and focused on the patients' needs as people would like to think. Pharmaceutical companies are particularly ruthless, many of them spending millions of dollars per year to convince doctors to prescribe their drugs and to convince consumers that their specific brand of drug is needed in order to cure their ailments. For instance, they may present symptoms that are perfectly harmless, and lead potential citizens to believe that, because of these symptoms, they are "sick" and in need of medication.
The United States of America accounts for only 5% of the world’s population, yet as a nation, we devour over 50% of the world’s pharmaceutical medication and around 80% of the world’s prescription narcotics (American Addict). The increasing demand for prescription medication in America has evoked a national health crisis in which the government and big business benefit at the expense of the American public.
Ghosh, C. (2013). Affordable Care Act: Strategies to Tame the Future. Physician Executive, 39(6), 68-70.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
The United States (U.S.) has a health care system that is much different than any other health care system in the world (Nies & McEwen, 2015). It is frequently recognized as one with most recent technological inventions, but at the same time is often criticized for being overly expensive (Nies & McEwen, 2015). In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) (U. S. Department of Health & Human Services, n.d.) This plan was implemented in an attempt to make preventative care more affordable and accessible for all uninsured Americans (U.S. Department of Health & Human Services, n.d.). Under the law, the new Patient’s Bill of Rights gives consumers the power to be in charge of their health care choices. (U.S. Department of Health & Human Services, n.d.).
In order to make ones’ health care coverage more affordable, the nation needs to address the continually increasing medical care costs. Approximately more than one-sixth of the United States economy is devoted to health care spending, such as: soaring prices for medical services, costly prescription drugs, newly advanced medical technology, and even unhealthy lifestyles. Our system is spending approximately $2.7 trillion annually on health care. According to experts, it is estimated that approximately 20%-30% of that spending (approx. $800 billion a year) appears to go towards wasteful, redundant, or even inefficient care.
In order to address the issue of rising healthcare expenditures and the increasing cost to Pennsylvania’s Medicaid program, it is imperative that the use of CER be adopted to identify and promote the use of medical practices which are cost-effective and produce the greatest patient outcomes. It is equally important however, that any CER policy is implemented in a manner that will ensure that government directed healthcare rationing cannot occur. There are several possible options which may allow for the adoption of an effective and fair CER policy in Pennsylvania.
In sum, America needs to reevaluate the status quo surrounding medical care. It is becoming increasingly apparent that the current model only benefits a select few and causes insufferable costs for the rest of the world. If there is no reform for these issues, money will continue to be siphoned directly into the pockets of large, for-profit companies that benefit from the strife of
Managed care, managed care has become the dominant health care delivery source. Gaining popularity in 1990s, managed care increased from 27% in 1988 to 99% in 2009 and enrollment in Fee for Service plans decli...
In today’s healthcare system, there are many characteristics and forces that make up the complex structure. Health care delivery is a complex system that involves many people that navigate it with hopes of a better outcome to the residents of the United States. Many factors affect the system starting from global influences, social values and culture. Further factors include economic conditions, physical environment, technology development, economic conditions, political climate and population characteristics. Furthermore the main characteristics of the Unites States healthcare system includes: no agency governs the whole system, access to healthcare is restricted based on the coverage and third party agencies exist. Unfortunately many people are in power of the healthcare system involving multiple payers. Physicians are pressured to order unnecessary tests to avoid potential legal risks. Quality of care is a major component; therefore it creates a demand for new technology. A more close investigation will review two main characteristics and two external forces that currently affect the healthcare delivery system. Furthermore, what will be the impact of one of the characteristics and one of the external forces in review with the new affordable care act 2010? The review will demonstrate the implications to the healthcare delivery system and the impact on the affordable care act 2010.
There are new challenges every year in the health care field. Research on the future of U.S Healthcare System is of paramount importance to the entire Health care industry as well as the citizens of the U.S. To begin with, the research will discuss how challenges for future healthcare services can be enhanced by reducing the costs of medication. By creating a better quality of health care, Information technology advancements, including future funding, lower rising costs, the Medicare and Medicaid programs. The research will also discuss the challenges of market shares for different ages of populating and maintaining a skilled work place. It will further discuss the tentative solutions to these challenges. The role that the government plays to ensure that these challenges are mitigated and that health care is available to all American citizens is also discussed. Among these problems poor quality of care is perhaps the most visible and troubling, resulting in nearly 100,000 preventable deaths each year (Institute of Medicine, 1999) and reduced quality of life for millions of Americans due to non-fatal yet serious adverse events such as wrong-limb amputation, hospital-acquired infection, and medication errors (Institute of Medicine, 2006; Leape, 1997).
Medicine, medical supplies, and medical treatment are multi-billion dollar industries crucial to the wellbeing of the public. Doctors and other members of the health-care industry do their best to provide excellent care for the nation’s sick and injured, while scientists and researchers work to develop new drugs and technologies to fight disease. We often view medical care as a basic human right; something that all persons, rich or poor, should have access to in times of need. But despite our notions of what healthcare should be, those who make a living in this industry, specifically owners of firms, must contend with the same economic questions facing businesses in any industry. To learn more about this vast service industry, I interviewed Dr. Martin Slez, a dentist/oral surgeon and owner of a medical practice that provides both general care and specialized treatments for oral diseases. Of the topics discussed, firm goals, pricing, costs, and technology stood out as particularly interesting and unique facets of the organization, as they differed considerably from those in other industries.
The cost of US health care has been steadily increasing for many years causing many Americans to face difficult choices between health care and other priorities in their lives. Health economists are bringing to light the tradeoffs which must be considered in every healthcare decision (Getzen, 2013, p. 427). Therefore, efforts must be made to incite change which constrains the cost of health care without creating adverse health consequences. As the medical field becomes more business oriented, there will be more of a shift in focus toward the costs and benefits, which will make medicine more like the rest of the economy (Getzen, 2013, p. 439).