Wait a second!
More handpicked essays just for you.
More handpicked essays just for you.
Competitive market analysis in healthcare
Competitive market analysis in healthcare
Don’t take our word for it - see why 10 million students trust us with their essay needs.
Recommended: Competitive market analysis in healthcare
In the medical industry, the quality of demand always remains constant despite the changes in prices and quality of services being provided. There usually is need for a regulatory agency to keep an eye on the market forces in the business so as to ensure the patients are not exploited. There are several regulatory agencies in the healthcare sector and it at times can be overwhelming (Stange, K. 2014). The main regulatory agency is the government, but it has several other agencies under it. These regulatory agencies play a role in not only the medical industry but also in the health insurance coverage. One of the regulations put in the industry is one the insurance cover. It is stated that the insurance covers only certain medical emergencies,
“One of those obligations is that it must exercise a proper degree of care for its patients, and, to the extent that it fails in that care, it should be liable in damages as any other commercial firm would be
Claims sent to the insurance companies could be rejected or denied. A health care facility is there to help people with their health, but they are a business that needs income to stay in business. If a medical facility or physician files a claim that is incorrect the Center for Medicare and Medicaid Services may get involved, this could mean audits, fines, or worse. Medical coding and billing are very precise and detailed work where mistakes can cause serious problems.
regulations - what's next? Health Matrix: Journal of Law and Medicine 2, no. 1 (Spring): 49- (22 p).
Medical malpractice has become a controversial social issue. From a doctor’s standpoint, decisions and preventative actions can alter the medical malpractice lawsuits filed against them. In order to protect their career and professional life medical malpractice insurance is available. Medical professional liability insurance, sometimes known as medical malpractice insurance, is one type of professional liability insurance. “Professional liability refers to liability that arises from a failure to use due care and the standard of care expected from a person in a particular profession, in this case a doctor, dentist, nurse, hospital or other health-related organization” (Brandenburg, 2014).
In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology.
Healthcare providers must make their treatment decisions based on many determining factors, one of which is insurance reimbursement. Providers always consider whether or not the organization will be paid by the patients and/or insurance companies when providing care. Another important factor which affects the healthcare provider’s ability to provide the appropriate care is whether or not the patient has been truthful, if they have had access to health, and are willing to take the necessary steps to maintain their health.
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.
risk, for drugs and medical devices, weighing risks against benefits is at the core of
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
The United States health care system is one of the most expensive systems in the world yet it is known as being unorganized and chaotic in comparison to other countries (Barton, 2010). This factor is attributed to numerous characteristics that define what the U.S. system is comprised of. Two of the major indications are imperfect market conditions and the demand for new technology (Barton, 2010). The health care system has been described as a free market in
The federal government acts in less-developed nations in a different manner in regards to minimum role in regulations regarding health care. This minimum role would lead the government to regulate safety at the regional or national level in which health care providers must be licensed and medications along with devices can be monitored (Tang, & Eisenberg, 2014). Federally this easy task can be regulated through monitoring devices, along with prec...
6. The special characteristics of the U.S. health care market are Ethical and equity considerations, asymmetric information, spillover benefits, and third-party payments: insurance. Each one of these characteristics affects health care in some way. For example, ethical and equity considerations affect health care in the way that society does not consider unjust for people to be denied to health care access. Society believes that it is the same thing as not owning a car or a computer. Asymmetric information also gives health care a boost in prices. People who buy health care have no information on what procedures and diagnostics are involved, but on the other hand sellers do. This creates an unusual situation in which the doctor (seller) tells the patient(buyer) what services he or she should consume. It seems like the patient has to buy what the doctor tells him. The topic of spillover benefits also cause a rise in prices. This meaning that immunizations for diseases benefit not only the person who buys it but the whole community as well. It reduces the risk of the whole population getting infected. And the last characteristic is third-party insurance. Which involves all the insurance money people have to pay. This causes a distortion which results in excess consumption of health care services.
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.
The regulation and licensing of health care providers in United States is governed separately by each state. The laws for providing license also vary from state-to-state without any reciprocation. There has been a very strong debate with respect to having a mandatory license to regulate health care providers. Many believe that healthcare providers can practice without authorized license. However, my opinion contradicts the above statement. Standard license laws are made to protect the consumers from fake and fraud practitioners. Can you image your life and money in the hands of someone that has no adequate skills or a charlatan fooling you. licensing the health care providers aids the government to maintain the control measures. This is done