Stakeholder in Us Health Care, Essay Example

Provider

This essay discusses two major challenges faced by health care providers in United Sates of America. Health care provider is categorized as a person or an institution offering rehabilitative; preventive, promotional and curative health care services. This care is executed systematically to benefit the public for which it was intended. Families and communities participate in creating accessibility to the available health care resources dispensed though different categories of providers (Gupta, 2011).

Individuals who function as health care providers are nurses; doctors; pharmacists; dentists; medical assistants and immense categories emerging in the health care system daily. Healthcare   provider institutions are hospitals, clinics; rehabilitation centers; nursing homes and skilled nursing care facilities. For the purposes of this discussion healthcare the provider stakeholder to be evaluated would be the physician in the ma nagged healthcare system ( Gupta,  2011).

Managed Healthcare Physician Challenge 1: Managed care functions

Under the managed health care system designed by department of Medicare/Medicaid physicians are classified healthcare providers. However, execution of their functions according to privileges grated to them within this framework could become very challenging. For example, physician providers have to operate within a network consisting of specialists, pharmacists, pharmacies; hospitals; laboratories and long-term care facilities. Consequently, their scope of caution is limited. The rationale for this strategy is to reduce costs and assist providers within the network to create more income ( Kongstvedt, 2001).

While this may be the analysis for the closed circuit services many providers complain that the system is not beneficial since on many occasion they have go function against their conscience when referring clients to co-provider in the network. Some of these services are mediocre and some services are cheaper and better from co-providers who donot operate within that network. If physicians have a moralobligation to offer the best services to their clients thenthis becomesa moral dilemma (Kongstvedt, 2001).

Managed Healthcare Physician Challenge 11: Managed care services

Physician healthcare providers have many options for offering their services. One such option is the Independent Practice Association (IPA). This is a legal organization contracting with a group of physicians offering services specifically to HMO’s members. Usually these physicians while functioning within the managed care protocol are paid on a capitation basis.Thismeans that in order to maximize their income, they must have enrolled a certain amount of clients for which they are assigned. In addition whether these clients are seen by them or not a specific amount of money is received by the provider (Kongstvedt, 2001).

These physicians still operate within a network for referral purposes. While the options seem beneficial to the provider for services rendered income is limited to how many patients are assigned to the provider within a given period. Consequently, they sign contracts with many HMOs to ensure adequate amounts of assignees. Essentially because the contracts with HMOs are not exclusive, opportunities are there for them to see patients on a fee for service basis in enhancing their income. Managed care network was intended to offers network providers more clients and facilitate increase income. IPA it would appear forces providers to fish for themselves (Kongstvedt, 2001).

References

Kongstvedt, P. (2001).The Managed Health Care Handbook (4th edition) Aspen Publishers, Inc.,

Gupta, N (2011).Human resources for maternal, newborn and child health: from measurement and planning to performance for improved health outcomes. Human Resources forHealth,9(16); 43-56