Essay on "Financing Health Care"

Essay 3 pages (1240 words) Sources: 3

[EXCERPT] . . . .

Financial Management

Criticisms of medical 'gate-keeping' highlight the inherent inequities within the American healthcare system. Gate-keeping by HMOs (health management organizations) was instituted when actuarial data indicated that consumers would tend to 'over-consume' medical procedures and care when given carte blanche insurance privileges. "In the 1970s, the RAND Corporation conducted a major study of the effect of different health insurance patterns on health care utilization and outcomes for working age people and their children. This study showed that when co-payments were applied, utilization of health services declined dramatically" (Kane et al. 1996). There is a tendency to over-test out of concern to 'just make sure' that something is not wrong, or to seek treatment of dubious efficacy 'in case it might work.' In the absence of gate-keeping there a financial incentive for physicians to provide additional care if they are confident they will be reimbursed for their actions. Also, physicians wish to please their patients, and patients often associate better care with more care. Managed care was instituted as a way of evaluating whether certain procedures were tested to be effective based upon research and actuarial data.

However, the problem with managed care is that non-physicians frequently evaluate whether procedures or tests are needed based upon generalized surveys, without adequate attention to patient data. The wide variance in insurance coverage of different treatments is evidence that it is difficult to 'prove' that something is inherently better or worse based upon demographic data. Health insurance companies also have a powerful incentive to deny care,

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even life-saving care, to improve their bottom line and frequently give physicians financial incentives to avoid prescribing costly but potentially beneficial treatments. "With an over-riding incentive for under-service, the burden of proof is on those who propose more intensive geriatric services or LTC" or more intensive treatments and screenings (Kane et al. 1996)

There is no question that in America many people are over-treated and over-tested while others have no health insurance at all. However, the solution to this dilemma is not reducing current levels of care, rather the solution is providing health insurance to all citizens and having a singular, objective regulatory government institution, staffed by healthcare professionals, to provide intelligent rationing of care. Health care should not be rationed by practitioners or insurance industry bureaucrats with a financial incentive to provide or not provide care.

Question 2

At present, healthcare in America is 'rationed' based upon who possesses the best insurance, rather than upon who has the greatest need. When health insurance is allocated almost entirely through employers, everyone loses out. Society is less healthy, given that people during their most productive years often experience gaps when they should be screened for medical conditions and receive preventative treatment to prevent chronic illnesses later in life. Today, because of concerns about costs, people may even self-ration their own medication, simply because their co-pays are too high, because they have no insurance, or their insurance is not comprehensive enough to cover treatment.

Fears about rationing end-of-life care stifled debate in America and encouraged people to see healthcare in black-and-white terms. Most of the other major industrialized nations have evolved certain models of care to allow for comprehensive coverage, either in the form of nationalized healthcare in England or requiring private insurance companies to give healthcare to all citizens, regardless of preexisting conditions or income. Healthcare must be regarded as a right, not a privilege. Americans who must work multiple part-time jobs or who work for very small employers (or who are self-employed) often cannot afford health insurance. These hard-working Americans should not be denied coverage simply because they are not fortunate (or do not desire) to work for the government or a large organization that can provide… READ MORE

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Quoted Instructions for "Financing Health Care" Assignment:

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Exercises:(80 points)

1. The various kinds of health professionals are educated in separate schools but with considerable overlap in curricula and training requirements. They are, however, expected to integrate their training and work together after graduation. Identify the advantages and disadvantages of this approach to professional education in terms of costs, educational efficiency, and patient care quality.

2. An oversupply of physicians in many urban regions contrasts with continuing problems of access in rural and inner-city areas. Why does the mal-distribution of physicians persist in spite of the number of physicians graduated?

3. The health care delivery system now places increased emphasis on maintaining wellness and on promoting disease avoidance through healthy behaviors and lifestyles. What challenges does this new orientation pose for our existing system of medical education and training?

Option 2: Additional Discussion Question (Module 4)

Please respond to one of the questions that you did not respond to on the required discussion posting separate paragraph end of essay

In 1992, medical residency programs in the U.S. were described as *****"responsive principally to the service needs of hospitals, the interests of the medical specialty societies, the objectives of the residency program directors, and the career preferences of the medical students.*****" In fact, there are so many more residency programs than can be filled by American medical school graduates, that an annual influx of foreign educated physicians has been required to satisfy the service needs of many hospitals. In addition, until recently, there has been no attempt to match America*****s needs for various kinds of specialty and generalist physicians with the hospital-based training programs that were producing them. In light of these facts, pose an opinion on ONE of these questions:

*****¢ Since the taxpayers fund medical residency training, shouldn*****t there be some planned balance between the needs for various kinds of physicians and the number of sites for their clinical training?

*****¢ Few graduates of medical school choose primary care, and instead flock to specialties with greater pay and prestige. Since primary care is the basis for maintaining health and early diagnosis of potential health problems, who should be responsible for rectifying this misplaced emphasis of health care*****¦*****¦. insurers*****¦medical schools*****¦the government*****¦the AMA*****¦others?

*****¢ Since there are not enough American medical school graduates to fill the residencies of the smaller non-teaching hospitals, would not the employment of nurse practitioners, physician assistants, or young physicians starting practice be considered first, before recruiting foreign medical graduates?

Attach your assignment as a Word document or comparable file format.

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