One of the major problems with Health Management Organizations is that they can encourage doctors to withhold care from their patients. HMOs offer financial incentives to physicians to withhold necessary care from patients and doctors risk being expelled from HMO networks if they provide costly treatments or tests. Capitation can be one major cause of this. Capitation is the amount of money that the doctor receives for each patient, whether or not the doctor treats them. This can create incentives to deny rather that provide care. The fixed amount per patient represents a large profit for the HMO is patients need only an annual checkup- but doesn t come close to paying for expensive tests or treatment of, say, diabetes of arthritis. Capitation is not the only cause of doctors wanting to withhold care. Some plans give a bonus of sorts to cost-conscious doctors. An organization might withhold ten percent of its negotiated payment to health care providers until the end of the accounting period. If the group, or in some cases, an individual doctor is under budget, the withheld payment is distributed as a quasi bonus. If too many patients require more care than was budgeted, some or all of the withheld payment is forfeited.
The Term Paper on Doctors Listening Skills Patients Patient Medical
Doctors' Listening Skills When people go to the doctor's office they want the doctor to listen. Competency and a correct diagnosis are appreciated too, but more than anything, patients value doctors's i lence (Richards, 1407). In addition, patients want "more and better information about their problem and the outcome, more openness about the side effects of treatment, relief of pain and emotional ...
These bonuses can be big incentives for doctors to withhold care, even under needy circumstances. David Himmelstien, co-author in the New England Journal of Medicine said that if a typical practice were made up just of patients from US Healthcare (an HMO with whom he had a contract) the practitioner s annual capitation fees would total 124,000 dollars, roughly what it costs to run a practice. The doctor s actual income would come from the incentives. There are quite large bonuses for decreasing the amount spent on emergency care, or specialist care, or hospital care. If a doctor could hit all of the bonuses, his gross income would be 256,000 dollars. Not only do HMOs offer incentives to doctors who cut care, but they also are cutting benefits themselves. Recent events suggest that consumers are increasingly feeling the pinch when their HMOs get squeezed. Members at Medicare HMOs in Pennsylvania, Maryland, and California recently learned that their plans were slashing pharmacy, vision and other benefits because of financial pressures. Last month Aetna US Healthcare said it would stop offering certain fertility treatments to some 780,000 women in its basic plan because they re so expensive. And Oxford Health Plans, whose expenses got wildly out of hand plans to pull out of Medicaid in Connecticut, forcing 33,000 people into new plans. There are also horror stories of patients not getting the care that they needed. They included, Mom Recalls How Baby Died as She Pleaded for Help, and Ex-New Yorker is Told: Get Castrated So We Can Save. It was all in there, day after day: people dying because of denied care and denied pharmaceuticals,
dying because their HMOs were denying costly treatments for breast cancer like high-dose chemotherapy with bone marrow transplant. In the castration case, a 76-year-old-man was ordered by his HMO to undergo the operation as a cost-effective alternative to his monthly injections of Lupron. This drug suppresses the production of male hormones, a function necessary to keep the man s prostate cancer in check. Not only is the quality of care affected by HMOs but also the patient s choices are affected. John M. Ruder, associate professor of health economics in the Sloan Graduate program at Cornell warned, As the historic frameworks in health-care delivery unravel, there is every reason to fear that medical decision-making in the emerging system will not be efficient from either the individual s or the social perspective. Traditionally, the economic view of medical decision-making considers two perspectives: the individual s, which assumes that each person retains autonomy to pursue what he or she wants or needs medically, and the social perspective, in which health services are viewed as a socially meritorious product that is guaranteed, at least to some extent, to everyone.
The Coursework on LFE Report On Health And Medical Services
1.0 Introduction The terms Health and Medical services are interrelated to each other and increasingly central to our lives. Bangladesh is a land of hard working souls and the major population of this nation dwells in the rural areas. LFE has been designed to provide a brief knowledge over the living structure and social and economic and also the health condition of the rural areas of Bangladesh. ...
To a great extent, Ruder pointed out, efficiency criteria and medical decision-making are different for both perspectives and seemingly in conflict when social programs and private consumption compete for the same scarce resources. The growth of aggressively competitive managed-care firms, mostly for-profit, however is dramatically influencing the way health care is delivered and how and why medical decisions are made. The developments and the subsequent alterations in medical decisions that are the inevitable result of these changes must be evaluated against the dual efficiency criteria, says Ruder. With managed-care companies having a very strong financial motive to change health-related decisions about used of health resources, patient and physicians medical decisions will continue to be the target of drastic change. HMOs also limit the types of services the patient can have performed. Complementary medicine, including Environmental Medicine, acupuncture, homeopathy and orthopedic medicine is endangered. In Canada and the USA a growing number of MDs are investigated, offices raided, and licenses revoked for practicing and using techniques of complementary medicine.
The quality of medical care in HMOs is inferior to the care provided in traditional fee-for-service physician practices and HMO doctors aren t as good as fee-for-service doctors. Quality in health care means an unlimited choice of doctors and services. Organizing select networks of doctors, hospitals, pharmacies, and other health care providers does not help the case. The medical decisions in HMOs are made by callous, number-crunching bureaucrats bent only on increasing the health plan s bottom line. HMOs are all big, for-profit corporations. Should health care really be like this? Doctors withholding care because they get a bonus at the end of the month, HMOs refusing to provide services to its customers. I think that health care reform is necessary. This huge gray area between managed care and fee-for-service must be clarified.
The Term Paper on Managed Care Health Services Hmo
... instance, HMO's not only offer medical care when a person is sick, like other traditional health insurance plans, but offer a variety of services to ... planning. Concurrent utilization review occurs when decisions regarding appropriateness are made during the course of health care utilization.An example of this would involve ...