Peer Response's: Please respond using about 5-8 sentences, contribute one fact.
• Pamboukian
Managed Care organizations have had a profound impact on clinical practices. Its aim is not only to provide cost effective care but also to regulate the necessity of care needed for patient unlike fee-for service payment where doctors rewarded for providing more care in order for them to collect more fees. Some assume that MCOs reduction of cost led to a reduction in the quality of care. But, according to some supporters of MCOs no consistent relationship between cost and quality of care was detected. Some opponents argue the impacts of MCOs on quality of patient care such as the article by Szilagyi in the journal issue. The article covers in more detail the impact of managed care on utilization of and access to health care services for children. Such impacts include (Bergman & Homer, 1998)
• Limitation the Benefit Package: Public and private services work in close concert with MCOs to bring cost of insurance packages down. However, this has caused in reducing the insurance packages provided. "A survey of 59 HMOs found that 42% to 62% did not provide coverage for ancillary services such as physical therapy, speech therapy, and occupational therapy" (Bergman & Homer, 1998)
• Restricting the provider network: Small panel size of providers have caused limitation on children with special needs due to limited access to pediatric specialists with expertise in rare childhood condition.
• Vanscoy
Managed Care is a health care delivery system that aims to assist with cost, utilization, and quality ("Managed," n.d.). The goals of managed care are to deliver Medicaid services to beneficiaries, while reducing program costs and allowing for better utilization of health care services ("Managed," n.d.). While all of these are wonderful goals, the healthcare reform and changes with medical coding and billing may bring some challenges (Pizzi, 2010). In addition to this, an increased burden on Medicaid system, due to the new eligibility requirements may surface.
The healthcare reform, which brings legislation changes at federal and state levels, may bring challenges to hospitals. Many people are now insured, the Congressional Budget Office estimated 32 million people will gain health insurance with the reform (Halupa, 2011). Not only does this bring changes to insurance markets and payments, but to how organizations manage care. Some possible negative side effects to the healthcare reform in the hospital settings are decreases in medical technology due to additional taxes and longer wait times due to physician shortages (Pizzi, 2010). Longer wait times can lead to a multitude of issues such as lack of proper diagnosis or the inability to perform the proper tests. Another challenge hospitals face with managed care are the changes with medical coding and billing (Pizzi, 2010). For example, the recent change to ICD-10 coding. It was originally ready to be released before all staff had proper training, which brought many delays.
• Loska
What are the characteristics of a "public good"? Why is it difficult for a private company to provide a public good? Explain in the economic and health care context.
Public good v.s. private good. Private goods are items that you have to purchase before using. Public goods are items that you can't feasibly charge for, such as public roads or public fireworks shows. There are two characteristics of a Public good; it must be nonrival and nonexcludable. Nonrivalrous goods are goods that many people can enjoy at the same time, at no additional cost. Nonexcludable goods are goods that you can't exclude other people from using. These two characteristics epitomize the difference between a public good and a private good.
Private companies would have a hard time producing a public good, because economically, private companies rely on profits from services they provide. In a healthcare setting, this could be described as a privately owned hospital, and if a patient can't afford the cost of services, they have to find care elsewhere. A non-profit, public hospital provides services whether a patient's insurance covers it, and the losses are written off.
• MACK- POSITIVE EXTERNALITY
Positive Externality is when a person who is not involved in a transaction receives a benefit as a result of the transaction.
The first thing that came to mind was herd immunity. Herd Immunity occurs when almost an entire population is vaccinated, and an vaccinated person who is part of that community is protected because everyone around them is offering a form of protection due to the fact that they cannot contract the virus reducing the chance that it can be caught and spread.
Another example could be in 2010, Hood College in Maryland wanted to see if there was a benefit to students and faculty having an iPad. The school realized that there was since students who had them were able to participate more interactively. As a result of studying the benefits, in 2012, all students who were enrolled in at least 6.5 credits were eligible for an iPad.