Health Care Delivery Structure in Georgia - Case Study Example

The Healthcare Market Affiliation: Analyze the current health care delivery structure in your state (Georgia). Compare and contrast the major determinants of healthcare market power. Insurance organizations Insurance organizations hold the majority of the market power in health care in Georgia. This is evident from the high financial plan in the insurance companies that makes people unable to afford having a good health care plan for themselves and their families. Statistics in Georgia indicate that out of the population of over five million people in the state, 18% are uninsured in some form of insurance plan. For those insured, half of them have the public insurance coverage that covers only the mere basics in health care which is not enough. The rest who get private coverage through employers are also weighed down by affordability costs (Zeldin, 2009). Hospital administration Hospital administrations also hold the market power in this state. Hospitals which are less compared to the population in the state have very high treatment plans be they for preventive or curative care. This therefore means that even individuals with insurance have to dig deeper into their pockets to get the proper treatment and especially when it comes to serious chronic diseases. People with the public health insurance coverage cannot get quality medical care simply because their insurance coverage compared to the hospital’s financial plan is just too meager. It is no wonder then that people fail to go to hospital and especially for prevention medicine. Physicians Physicians are the other group holding the health care market power. There are few hospitals and specialized trauma centers in the state compared to the population. This therefore boils down to fewer physicians for the number of patients. With fewer general physicians, there are even fewer specialized physicians which mean that their access by the public is limited due to their exorbitant consultation fees. This therefore leads to fewer people (only those with a lot of money) getting access to proper specialized and quality health care. Analyze the main competitive forces in the your healthcare delivery system in your state, and compare the major factors that influence the fundamental manner in which these competitive forces determine prices, supply and demand, quality of care, consumerism, and providers’ compensation The continual increase in the private practices is the main competitive forces of the healthcare delivery system in Georgia. As the number of private practices increase, the physicians in the hospitals tend to reduce. Even if they are available, they only come in for few hours and not even during weekends and then leave to attend to their private practices. This therefore means that fewer people in the hospitals get the opportunity to get specialized medical services unless they seek the private services which are very costly (Sanfilippo, Nolan and Whiteside, 2002). With the specialized services being provided in the hospitals decreasing, and people being forced to seek the private services, the consultants in the private practice take advantage to increase their consultation fee and other prices. They enjoy having reduced or no competition at all for their services that have been partially removed from the public eye and hence determine the prices to charge their patients. They also provide the best quality care in their private practice compared to what they are providing or what is being provided in the hospital. This therefore ensures that they have a high demand with an endless flow of patients despite the exorbitant prices being set. They in turn compensate their meager earnings in the public sector with the income from their practices. Evaluate the positive benefits and negative aspects, respectively, of HMO managed care from the provider’s point of view—i.e., a physician and a healthcare facility—and from a patient’s point of view. Provide a rationale for your response. The providers of HMO who are the HMO physicians and the specific HMO healthcare facilities have more advantage and fewer disadvantages with the plan compared to the patients. The physician on duty has to see all the patients reporting on that day and he or she is paid according to the number of patients seen. This is a better financial plan than other doctors who can see many patients but the pay is still standard. The health care facility is up for rent and hence rent is paid as per the agreement of the contract. The disadvantage for the doctors is that there are other patients who may need referral even before they get checked by the doctor on duty. This brings conflict between doctor and patient and has led to several lawsuits being filed against the system. There are other patients who want to visit without appointments against the policy of the healthcare plan while others refuse to co-pay after the treatment. As for the patients, this plan is cheaper and more effective in payment than the other insurance. One does not even need to have the money for co-payment when visiting the healthcare facility and can make the payment together with the monthly fixed charge. This is an indication that they prioritize health first and finances later. The disadvantage with the HMO plan is that they do not take emergency cases as one has to make prior appointment first. In case of emergencies, the patient even with the HMO plan has to go to emergency room in another hospital and pay with their own cash from the pocket which is highly inconveniencing and especially since one has insurance cover. The other disadvantage is in regards to specialized services and physicians. An individual chooses the doctor they will be seeing when filling the HMO forms. IN case of specialized services like pediatric care, on has to first of all go through the physician chosen that can then make referral to the specialized doctor. After the referral, appointment has to be made to go see the physician. This process is long and highly inconveniencing (Sanfilippo, Nolan and Whiteside, 2002). Assess the efficiency of the types of economic incentives available to providers in the delivery of healthcare services in your own state. Numerous people cannot afford private insurance and they operate on the different available public forms of health insurance that demands them to pay a little additional fee for treatment. As for specialized treatment, they have to pay a substantial amount of money all which goes directly to the physicians working with the patient. This form of payment and insurance provides great economic incentives for those providing the health care service delivery especially in the state of Georgia (Sanfilippo, Nolan and Whiteside, 2002). The good thing with Georgia is that half its population has this form of public insurance and hence has to pay majority of the time with their money as the insurance does not cover them in most services. With the low number of physicians compared to the population in Georgia, the physicians need economic incentives which can make them remain working instead of seeking other jobs to finance themselves and get the pay for their work (Zeldin, 2009). The economic incentive being provided in this state is that the local government in collaboration with the private sector is offering to fund the consultants’ private practices as a way of enticing them to continue working in the state. The incentives lead to these physicians seeing many medical patients both in the hospitals and in their private practices as well. With the reduction in the number of physicians as well as the increase in the number of patients, the workload for the remaining healthcare providers is a lot. The health care organizations are overwhelmed with work and little money to spare for recruitment exercises. In order to provide incentives for the healthcare workers, private recruitment services have been set up to solicit and hire assistants and additional physicians all at a free cost to the health care organizations. The saved money goes towards additional compensation for the healthcare providers at work. Propose who bears the financial risk of a capitation payment system: the provider, the patient, or the consumer-driven health plan itself. The financial risk of a capitation system is assumed by the provider of the plan which in this case is the administration of the HMO. This is so because in this type of payment system, the patient pays at the end of the month and the co-payments in case they visit the doctor. The monthly payment is fixed no matter how many times the patient visits the physician’s office the cost cannot be increased (Cox, 2011). The physician providing the health care services is also paid in advance by the capitation system. The payment is made according to the number of services which will be made as well as according to the number of patients who have subscribed to the HMO in that specific locality. The payment made in advance is regardless of the patients who will come for the physical checkup or to seek the services. If the number of patients is fewer in a particular month, it means that the provider of the health care plan will have a deficit of money. This is so because with reduced patients, there is no extra fee for the co-payment made by the patients and neither are there any additional fee for any specialized treatment as there were reduced patients. The physician however has already been paid in advance and the money cannot be called back. Other utility bills have to be cleared such as cost of medicines purchased that month in advance, payment of rent for the premise where the healthcare services are provided as well as assistants in that facility. The financial risk is therefore fully adopted by the HMO provider without any other party assuming the risk at that time (Cox, 2011). The only thing that will reduce the financial risk from increasing is that the physicians will not be provided any dividends as financial rewards as they did not have a lot of work that demands economic incentives or any other form of compensations. References Cox, T. (2011). Exposing the true risks of capitation financed healthcare. Journal of Healthcare Risk Management, 30: 34–41. Sanfilippo, J., Nolan, T. and Whiteside, B. (2002). MBA Handbook for Healthcare Professionals. New York: CRC Press. Zeldin, C. (October, 2009). Coverage, Access, Affordability, and Quality: With National Health Reform at Hand, Where Does Georgia Stand? Georgians for a healthy future. Retrieved from: http://healthyfuturega.org/pdfs/GHF_Health_Care_GA.pdf Read More