The Role of the Manager in Health System Finance - Essay Example

The Role of the Manager in Health System Finance 1.0. Introduction Health systems management is mandatory for any health system finance. Health system management entails general management of hospital networks- in general, all healthcare systems. On a broader viewpoint, this is to mean that management is done at all levels of healthcare systems. For management to be successfully, the manager has to be fully incorporated in the health system finance. The manager is solely involved budgeting of the health system program, so as to identify the amount of money needs to be allocated for a particular program, and what needs to be allocated for future healthcare ventures. As a broad field, the health system finance department needs a manager who ought to access and manage all funds in healthcare. The institutional and financial needs in this case will be available, due to well handling and running of funds. For healthcare institutions, methodologies of gaining funds range from grants, loans to government contracts. The manager in this instance has to come on board to organize all these funding methods. Economic evaluation is also possible with the full involvement of the manager in health system finance. This essay shall attempt to assess the role of the Manager in health system finance. The paper shall also explain the role of purchasers and commissioners in the fair allocation of resources, assess the viability of the use of clinical coding procedures for efficient payment and cost control, and finally evaluate the credibility of employing strategies to manage the effective use of coding systems in health care.  2.0. Body 2.1. The role of purchasers and commissioners in the fair allocation of resources. In the work of Smith & Curry (n.d.: 30), the purchasers and commissioners have a greater role to play in ensuring fair allocation of resources in the healthcare system. In their work, Smith & Curry (n.d.: 30), bring out the concept that commissioning refers to making purchase strategically or rather planning and funding. In the United Kingdom, commissioning is mostly used in the National Health Service (NHS). This entails coming up with decisions that touch on the health requirements of the population and the required services that are required to meet these needs. In this case, the purchasers and commissioners come in handy to check for proper allocation of funds and the necessary resources to deliver full services to the population. On another viewpoint Davies (2008: 25) indicates that the purchasers and commissioners play the role of monitoring the services that allow fulfil the standards put in place in the healthcare contracts. Of essence, this is to mean that commissioners are endorsed in office so as to work on policies that are beneficial to health planning and purchasing. However, in the United Kingdom, academic analysis is put in place according to Smith & Curry (n.d.: 30), so as to make a complete disparity between contracting and purchasing by the commissioners. Williams (1999: 406) indicates that in the UK, purchasers and commissioners have more of a proactive role that attempts to influence what is provided by the health suppliers. Regarding the National Health Service (NHS) in the U.K., purchasers and commissioners should be more involved in scheduling, designing and executing the services required of them by the health organizations, as opposed to being active purchasers (Smith & Curry, n.d.: 30). Smith & Curry (n.d.: 30) also emphasize that the commissioners decide which are the best services and healthcare interpositions that are valid for the concerned healthcare facilities. It is also the sole responsibility of the commissioners to determine the best suppliers, and how they will finance for the services and goods offered by the same. On a lighter note, the commissioners in the U.K context as portrayed by Smith & Curry (n.d.: 30) must be well conversant with techniques on implementing changes in conjunction with the health providers. In the work compiled by Tyson (2007: 5) purchasers shop for the necessary goods and services on offer at a particular time as well as recompense the providers on the basis of usage. In the case of U.K., the National Health Service (NHS) has ensured that purchasers and commissioners have played a proactive role; thus, posed a major challenge to all health providers that have rather been dawdling regarding the same. A case in point is the U.K. is where the healthcare purchasers have had powers to function nationwide and counter issues such flu prevention using specialized services, credit to the ‘one size fits all’ methodology applied by the United Kingdom’s commissioners (Smith & Curry, n.d.: 30). With continuity in the commissioning, as backed up by the National Health Service (NHS), dealing with the public health finance has been made easier (Smith & Curry, n.d.: 30). With the commissioners and purchasers in the United Kingdom having a long history dating back to the 1990s they have been charged with the responsibility of assessing the needs of the populace at large, scheduling for the healthcare services, and making sure that that the concerned services are made accessible and reachable for various populations needing the aid (Smith & Curry, n.d.: 31). Though Smith & Curry (n.d.: 31) indicate that commissioners and purchasers face a myriad of drawbacks in the course of dispensing their duties in the U.K.- ranging from political interference to over expectations from the entire health system- commissioners and purchasers have been on the frontline to perfect their roles. According to the Department of Health (2000:18), NHS commissioners in U.K. play the role of assessing the health needs and make directives on how the health needs need to be met. The commissioners also ensure that equity is evident in the delivery and access to the health services to the populace in general. The Department of Health (2000:18), also stipulates that the NHS plan has been on the frontline to ensure that primary care trusts (PCTs) identify health organizations that are in dire need, as well as shed more focus on most affected areas, and ultimately work on coming up with preventive treatments. NHS, in conjunction with the purchasers and commissioners, can be indicated to work towards dealing with health inequalities in the United Kingdom. 2.1. The use of clinical coding procedures for efficient payment and cost control and strategies to manage the effective use of coding systems in health care In any healthcare system, reimbursement plans must go hand in hand with coding and billing issues. The manager plays a great role in clinical coding or commissioning of healthcare. Wiley et.al, (2012: 77) indicate that in the U.K, improving efficiency is a number one priority for its citizens. In the work compiled by Sage (2004: 23), a lot of healthcare institutions incur huge amounts of losses for the reason that they do not code their patients accurately and completely. Subsequently, the institutions lose a lot of revenue. On the other hand, Wooding (2004:80) argues that healthcare administrators are not keen to implement good coding regulations. This means that these executives do not understand the technicality of coding; thus, massive losses in the overall financing of the healthcare institutions. According to Sage (2004: 27), coding refers to a process in which medical services, procedures and diagnoses are allotted alphanumeric. Proper coding classification system allows for creating details for reimbursement, capture the workload in healthcare units, determine costs and properly classify morbidity and mortality. Additionally, Petzel (2012:5) indicates that proper coding classification allows for data storage and easier retrieval in the health institutions. Petzel (2012:2) continues to argue that indexing of hospital records in terms of operations and infections is possible through proper clinical coding/ classification. Schraffenberger et al., (2005: 79) indicate that the managers are vital in ensuring that coding requires specialization, proper training and education of code assignments. In such institutions specific guidelines and procedures are well adhered to; thus, accuracy and consistency is present in presentation and report of code sequences. On another viewpoint, Petzel (2012: 6) indicates that informed managers are beneficial in capturing data, educating the employees and ensuring that coding is done consistently and accurately. In the work of Wooding (2004:81), it is evident that monitoring the accuracy and efficiency of the coding staff has been useful in efficient payment and cost control in the healthcare facilities. In the event that the manager continually reviews the coding system, fewer errors are reported, and if detected, are cleared on a need basis (Schraffenberger et al., 2005:229). Schraffenberger et al., (2005:3) urge managers to come up with ample ways of educating its staff regarding coding and always ensure they make necessary communication in the event of a change in codes. It is also of great essence to ensure that the managers always check for qualified staff members to serve as coding staff, if efficient payment and cost control has to be attained in the healthcare institution. 2.2. The United Kingdom in question According to the NHS Institute for Innovation and Improvement, (2011:1) and Stegwee & Spil (2001:23) boosting a more methodical coding and recording system has been a major aim for the U.K. healthcare system. Davidson & Heineke (2012: 361) argue that without a comprehensive coding system, it is almost impossible to accumulate a lot of money as compared to health organizations with consistent coding systems. The effective use of coding systems in health care has created a system whereby the healthcare practitioners are able to come with a consistent plan; thus, devise a methodology of assessing the accrued benefits (Davidson & Heineke, 2012: 361). Davidson & Heineke (2012: 361) and Engelbrecht (2005: 597) also argue that in the U.K. for instance, National Health Service (NHS) has managed to come up with plans that have connected all health practitioners and all concerned health providers. The effective use of coding systems in health care has helped in improving proficiency of care as billing has been made easier; as a consequence, greater income to the health facilities (Kirch, 2008: 264). In the long run, clinicians are able to attend to as many clients as possible, subsequently, collection of more funds, all with the backing of better coding (Davidson & Heineke, 2012: 361; Jackson, Gray & Brambleby, 2007: 1). Conclusively, it is validated to argue that the use of clinical coding procedures allows for efficient payment and cost control. Managers must always assess and address educational needs of all coding staff, for efficient health system finance operations. Of essence, coding managers are required to manage people, systems and processes, for flawless documentation and observance of the code guidelines. Petzel (2012:3) argues that managers must assume the role of the educator all in an endeavour to educate the staff members of the new requirements of the code regulations and issues. Interactive communication allows for effective working and transfer of data regarding the patients with minimal barriers. In relation to AHIMA (2011: 1), it is the role of health organizations to determine how to manage the emerging trends of data management and coding so as to analyse data in the correct manner. Managers must as a result have correct management skills so as to understand the coding complexities. In the case of U.K, consistency in coding has allowed for quicker exchange of information regarding its clients, as well as reuses the existing data for future reference. Tan (2001:101) argues that monitoring performance, analysis and planning has been improved in the U.K., therefore making decisions regarding clinical support is no task to managers. U.K has managed to devise a coding system that has witnessed minimal errors and indistinctness in the clinical errors. In this case, it is validated to argue that proper coding leads to clinical safety. Armoni (2002: 16) and Wager, Lee & Glaser (2009: 18) write on the benefits of coding in the U.K. that has seen reduced costs, and full auditability of clinical files. In addition, management of records in the U.K. has been made easy, clinical preparations more accurate, transport enhanced, and finally workflow efficiency has been a major characteristic of the health facilities in the U.K. It is worth arguing that without consistent coding organizational change is harboured, as well as the realignment of health information systems. Managers must endeavour that they assign codes, with the help of code browsers. 3.0. Conclusion From the essay, managers have a major role to play in Health Finance. Clinical coding, commissioning of healthcare and purchasing are exclusively placed under the managers. In relation to the practice and policy, it is recommended that the managers attempt to ensure that there is consistency in clinical coding and that the purchasers and commissioners work towards making health care facilities in the U.K. perform towards a cost reduction approach. As evident in the essay, managers must also play the role of the educator, if the policy of cost reduction has to be fulfilled in U.K.’s health care organizations. Proper employment of strategies of managing the effective use of coding systems in health care is a step towards refurbishing the healthcare system in the United Kingdom. Clinical coding procedures for efficient payment and cost control lead to minimal costs on the side of the health facilities; thus, more profits and cost reduction. 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