Running IHead: ILEGAL IAND IETHICAL IIMPACTS IOF IMANAGE ICARE IPRACTICES 1
Legal Iand IEthical IImpacts IThat IManage ICare IPractices Ihave Ion IQuality/ IAccess Ito IPatient ICare.
HSM- I544
Student: INAME IHERE
Professor: INAME IHERE
I
DATE.
I
, LEGALIAND IETHICAL IIMPACTS IOF IMANAGE ICARE IPRACTICES 2
Issue
INTRODUCTION/BACKGROUND.
A Ivast Iamount Iof Ihealth Icare Iin Ithe IUS Iis Iadministered Ithough Imange Icare Iplans. IWhat Iis
I manage Icare? IManage Icare Iis Irefers Ito Ia Ivariety Iof Imethods Ifor Iinfluencing Ithe Iclinical Ibehavior
of Ihealth Icare Iproviders Iand/or Ipatients, Ioften Iby Iincorporating Ithe Ipayment Iand Idelivery Iof
I
I health Icare. IThe Igoal Iof Imanaged Icare Iis Ito Icontrol Icost, Iquality Iand Iaccess Ito Ihealth Icare Iservices
in Ia Ispecific Ipopulation Iof Icovered Ienrollees I(Jecker, I2008).
I
The Iquality/access Ito Ihealth Icare Iservices Ithat Ia Ipatient Ireceives Iis Iquestionable Idue Ito Ithe
many Ichallenges Iassociated Iwith Ithe Ilegal Iand Iethical Iimpacts Iof Imanaged Icare. IFor Ione Ithe Iplans
I
are Inot Ieasily Iavailable Ito Ieveryone. ISome Iemployers Idon’t Ioffer Icompany Isponsor Iplans. IAnd
I
the Icompanies Ithat Ido Ioffer Ithe Iplans Ioffer Ithem Iwith Ia Ihigh Iout Iof Ipocket Iexpense Ifor Ithe
I
employee. IAnd Isome Iof Ithe Iplans Icome Iwith Itoo Imany Irestrictions. IFor Iexample, Isome Imanage
I
care Iplans Icontrols Ia Ipatient’s Iaccess Ito Ia Imedical Ispecialist. IThere Iare Ithree Imanage Icare Iplans
I
that Iare Ithe Imost Iprominent, Iwhich Iis Ihealth Imaintenance Iorganizations I(HMO), Ipreferred
I
provider Iorganization I(PPO) Iand Ipoint Iof Iservice I(POS). IThe IHMO IPlan Icontracts Iwith
I
physicians Iand Ifacilities Iin Iorder Ito Iform Ia Iprovider Inetwork. IThe Icopays Iand Ipremiums Iare
I
I normally Imuch Ilower Ithan Iother Iplans. IHowever, Ithe IHMO Ihas Ithe Ileast Iflexibility. IThe IPPO
plan Ialso Icontracts Iwith Ihealth Icare Iproviders Iand Icreates Ia Iprovider Inetwork. IThe Icopays Iand
I
premiums Iare Inormally Ihigher Ithe Iplan Ihas Ia Ilot Imore Iflexibility Ithan Ithe IHMO. IThe IPOS Iplan
I
offers Ia Icombination Iof IHMO Ihealth Iinsurance Iand IPPO Iinsurance Iservices I(Jecker, I2008).
I
Manage Icare Ican Ibe Isaid Ito Ibe Idesigned Iaround Ian Iarray Iof Iincentives. IIn Iorder Ito Igear Iup
and Iencourage Istaffs Isuch Ias Inurses, Iphysicians, Ithese Iincentives Iare Ibeen Ioffered Ijust Ito Iboast
I
Legal Iand IEthical IImpacts IThat IManage ICare IPractices Ihave Ion IQuality/ IAccess Ito IPatient ICare.
HSM- I544
Student: INAME IHERE
Professor: INAME IHERE
I
DATE.
I
, LEGALIAND IETHICAL IIMPACTS IOF IMANAGE ICARE IPRACTICES 2
Issue
INTRODUCTION/BACKGROUND.
A Ivast Iamount Iof Ihealth Icare Iin Ithe IUS Iis Iadministered Ithough Imange Icare Iplans. IWhat Iis
I manage Icare? IManage Icare Iis Irefers Ito Ia Ivariety Iof Imethods Ifor Iinfluencing Ithe Iclinical Ibehavior
of Ihealth Icare Iproviders Iand/or Ipatients, Ioften Iby Iincorporating Ithe Ipayment Iand Idelivery Iof
I
I health Icare. IThe Igoal Iof Imanaged Icare Iis Ito Icontrol Icost, Iquality Iand Iaccess Ito Ihealth Icare Iservices
in Ia Ispecific Ipopulation Iof Icovered Ienrollees I(Jecker, I2008).
I
The Iquality/access Ito Ihealth Icare Iservices Ithat Ia Ipatient Ireceives Iis Iquestionable Idue Ito Ithe
many Ichallenges Iassociated Iwith Ithe Ilegal Iand Iethical Iimpacts Iof Imanaged Icare. IFor Ione Ithe Iplans
I
are Inot Ieasily Iavailable Ito Ieveryone. ISome Iemployers Idon’t Ioffer Icompany Isponsor Iplans. IAnd
I
the Icompanies Ithat Ido Ioffer Ithe Iplans Ioffer Ithem Iwith Ia Ihigh Iout Iof Ipocket Iexpense Ifor Ithe
I
employee. IAnd Isome Iof Ithe Iplans Icome Iwith Itoo Imany Irestrictions. IFor Iexample, Isome Imanage
I
care Iplans Icontrols Ia Ipatient’s Iaccess Ito Ia Imedical Ispecialist. IThere Iare Ithree Imanage Icare Iplans
I
that Iare Ithe Imost Iprominent, Iwhich Iis Ihealth Imaintenance Iorganizations I(HMO), Ipreferred
I
provider Iorganization I(PPO) Iand Ipoint Iof Iservice I(POS). IThe IHMO IPlan Icontracts Iwith
I
physicians Iand Ifacilities Iin Iorder Ito Iform Ia Iprovider Inetwork. IThe Icopays Iand Ipremiums Iare
I
I normally Imuch Ilower Ithan Iother Iplans. IHowever, Ithe IHMO Ihas Ithe Ileast Iflexibility. IThe IPPO
plan Ialso Icontracts Iwith Ihealth Icare Iproviders Iand Icreates Ia Iprovider Inetwork. IThe Icopays Iand
I
premiums Iare Inormally Ihigher Ithe Iplan Ihas Ia Ilot Imore Iflexibility Ithan Ithe IHMO. IThe IPOS Iplan
I
offers Ia Icombination Iof IHMO Ihealth Iinsurance Iand IPPO Iinsurance Iservices I(Jecker, I2008).
I
Manage Icare Ican Ibe Isaid Ito Ibe Idesigned Iaround Ian Iarray Iof Iincentives. IIn Iorder Ito Igear Iup
and Iencourage Istaffs Isuch Ias Inurses, Iphysicians, Ithese Iincentives Iare Ibeen Ioffered Ijust Ito Iboast
I
