Crisis In The Health Care

Crisis In The Health Care
Crisis In The Health Care
Now that you have selected and carefully reviewed your case study, it is time to begin analyzing the situation the healthcare organization faces. In this milestone, you will evaluate the issue it faces in light of its mission, vision, and values.
Develop an analysis of the organization’s strategic planning approaches. Be sure to address the following:
Based on its mission and vision statements, what can you discern about the organization’s approach to strategic planning? Be sure to provide specific examples to justify your response.
What is the prevailing issue in question in the case study you selected?
What do you see as the overall strategic planning concerns for the healthcare organization with regard to this issue?
What role do you feel the healthcare manager plays in terms of strategic planning around this issue? Be sure to substantiate your claims.
Who are the key stakeholders affected by or involved in this issue, and what role do they serve in strategic planning within the organization?
Historically, health-care officials and policymakers have attempted to drive cost-cutting by offering incentives and modifying compensation schemes.
This strategy has limitations in terms of bringing about significant and fundamental change in the health-care delivery model, and it is frequently associated with unforeseen and negative outcomes.
Initially, insurance companies attempted to manage health-care costs using administrative measures such as excluding clauses and eligibility requirements, which imposed little restrictions on providers and did not necessarily reward more efficient care.
When this strategy failed and health-care costs outpaced economic growth in the early to mid-1990s (Figure 2),6 insurance companies and health plans shifted cost-control responsibility to providers through the rapid proliferation of managed-care organizations, putting providers at risk for the health-care system’s financial performance.
Managed care, according to conventional thinking, has failed.
Figure 2 shows, on the other hand, that the rate of rise in health-care costs dropped from 1990 to 1994, and then remained flat or negative from 1994 to 1997.
However, as people became more financially secure in the late 1990s, a growing proportion of Americans opposed to managed care’s limited nature.
Patients desired more options, and physicians resented the limitations.
As large, loosely organized independent provider networks (IPAs) arose, the ability to manage care and keep costs in check deteriorated quickly.
The outcome was predictable: health-care expenses rose at a time when the country’s economy was slowing and firms were facing more worldwide competition.
Many companies try to cut costs by eliminating health-care coverage.
Between 1999 and 2003, five million people in the United States went without health insurance (Figure 1).
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As a result of the apparent failure of managed care, many insurers and employers have decided to move cost-cutting responsibility from providers to patients.
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The idea is that financially involved patients, equipped with data, will make well-informed decisions about how to allocate resources—their health-care purchases.
Patients are financially involved under the consumerism model because they must balance large co-pays and deductibles with cash available in medical savings accounts to cover these expenditures.
If a person or family spends more than the amount available in their medical savings account, they must pay the difference out of pocket.
They can save money and use it to assist cover care expenditures in the future if they spend less.
Patients who are confronted with the financial consequences of their actions should theoretically become more cautious buyers.
We have some worries about consumerism’s suitability and effectiveness in promoting real reforms in the delivery system and lowering costs in the long run.
To begin, the cornerstone of consumerism is to provide accurate and full information to patients (consumers) so that they may make informed decisions.
Regrettably, public reporting of health data comparing pricing, quality, and outcomes among providers is still in its early stages.
There is no single, widely regarded source of trustworthy, easily understandable information for patients.
Even for the most experienced physician, let alone the general public, the information connected to a given ailment can be exceedingly complex, contradictory, and difficult to decipher.
Many consumers resort to the Internet, which is full of both good and questionable material, further perplexing patients.