Health Care Economics - Research Paper Example

Management Topic: Health care Economics The economic value of the health care industry is a topic of prime importance that has genuine relationship with the other industrial sectors of the economy. The industry of health care can be regarded as a pillar to the economic structure of a country on the grounds of circulation of health care generated dollars in the economy and the direct linkages it have with other industrial sectors. Apart from this the features of providing employment and generating revenue through purchases of utility services and other material are the direct contributions of this sector to the economy.(Connie Bodeen, 1998) Research aim and Objectives; Health care frauds are becoming a widespread problem at present time that needs immediate attention of authorities for raising preventive measures. In the year 2008 the reporting of US department of Health and Human service office of inspector general (OIG) reveals the elimination of around 3,000 personnel against accusation of health care related fraud and abuse. Out of these 575 were criminal graded actions and 342 were the civil action abuses. The estimated loss incurred out of the wastage was around $20.4 billion. ((OIG), 2008)The objectives of this research paper is to explore the implications of the cost of health care fraud, abuse and waste, depicting the various aspects of these activities and the measures government has taken in the form of rules and regulations. Health Care Fraud; The definition of Health care fraud in the United States Code is defined as, “knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program”(Law, nd). The illustration of law defines it as a white collar crime that induces illegal and harmful practices for the sake of earning profits. The various forms of frauds include unfair schemes, unnecessary hoarding of medicines to raise their price, billing against unoffered services or prescribing unneeded and unnecessary medication that lead a lot of Americans towards over medication and use of drugs that they don’t even need and also the other side.(CULS, nd) The example practices of health care fraud include billing for services that were not provided, intentional duplicate billing, erroneous prescription etc. Health Care Abuse; Health care abuse is the practice incurred for the sake of earnings out of prescriptions / applications that are not needed. The provision of goods and services that do not meet the standard of professional health care industry is health care abuse. The example of health care abuse include charging of unnecessary services or prescription of unwanted treatments etc Difference between Health Care Fraud and Health Care Abuse; the difference in health care fraud and health care abuse pertains with the nature of act. Hence, an act that results into unnecessary treatment / prescription falls under the category of health care abuse but the acts that deliberately aim to charge an extra cost out of cheating is counted in the definition of health care fraud. Waste; It refers to the provision of goods and services that were intended not to swindle or mislead but the payment methods that unintentionally raised the cost due to organizational errors. Rules and Regulations Related to Health Care related Fraud and Abuse; The various laws related to Health Care fraud and abuses are stated below for an overview; each of the below mentioned code followed by their clauses render a different impact on the case based on the execution. False Claims Act (FCA), 31 U.S.C., s. 3729 Florida False Claims Act, F.S. 817.234 Anti-Kickback Statute 42 U.S.C. s. 1320a-7b(b) Physician Self-Referral (“Stark”) Statute, 42 U.S.C. s. 1395nn Deficit Reduction Act of 2005 HIPAA of 1996, Title 18, Section 1347 Fraud Enforcement and Recovery Act of 2009 (FERA). Analysis; The concept of Evidence Based Practice is suggested for Health care control especially for wastage due to unnecessary treatment and methods to evaluate its relevance and contribution to practice. In order to have a clear over view of the illustration, this brief needs to be divided into four essential steps. The first step is to define and examine the concept of Evidence Based Practice and the summarise importance in practice by focusing the core issues. The second step is to devise a rationale to understand and comprehend the different reasons and situations that drive health care services towards wastage of goods and services for unnecessary treatments. The third step for achieving the objective is to examine various selected aspect of professional practice supported by research or different sorts of evidence, that could assist in the development of an action plan, which means the evaluation of proposals in the light of cases reported by regulatory bodies and discuss the different research available on the subject, such as, systematic review, quantitative and qualitative research. The four steps are equally important for the development of proposals with rational evaluation of different factors that could facilitate or otherwise can obscure the implication of the referred practice. The concept of evidence practice involves different approaches. According to Sackett et al (1996) the concept of evidence practice includes three elements: clinical expertise, knowledge of research evidence and Understanding of patient preference and choice. Clinical expertise means health care personnel must be answerable or liable for the incurred treatment on patients’ care delivery (LoBiondo-wood Hover 1990). This idea is also supported by the United Kingdom Council for Nurses and Health visitors Code of Professional Conduct (UKCC), which believes that nurses should be obliged for the care of patients and must necessarily, attain information to keep their knowledge and competence up to date. (UKCC 1992). Knowledge of research evidence means that health care personnel must have the ability to select relevant research and updates in clinical expertise to improve patients’ lives (McSherry et al 2002). For example, each individual should be able to utilise guidelines, protocols and other sources of evidence, and be capable of applying those correctly with a thorough understanding of patient’s preference. Understanding of patient preference means that health care personnel should be able to assess and make sure patients have sufficient information regarding their medical state and inclusion of efficient methods to involve the family and caretakers of the patient in decision making concerning their care delivery (DOH 1999). Gray (1997a) however disagrees with the approach developed by Sackett and his contemporaries on the ground of narrow vision of patients’ for decision making and related system organization. He believes that the idea about systematic research seems good, but is not relevant for all cases because of the absence of systematic review in certain areas of research. On the other hand he supports his argument with the statement that decision making from patient’s care delivery should be analyzed through obtaining accurate and authentic evidences. The other option he proposes is to rationally utilize research available for health care control by devising methods to educate the patients to have a clear picture view of their state that could possibly aid them in rational decision making concerning their care delivery (Gray 1997b). The argument is criticized by Sackets and his contemporaries on the fact that it does not offer a solution for patients without mental capacity (Mental Capacity Act 2009). In general, Evidence Based Practice is an approach that requires all healthcare professionals to use information from high quality of research that will certainly bring in a positive difference in health care control by presenting better solutions with less lope holes. (Kenworthy et al 2002). Taylor (2000) thinks that Evidence Based Practice can be classified in several categories following this hierarchy: The evaluation of primary research is referred from the term systematic review (Smyth 2002), randomised trial represents a study that spotlight observations drawn from experimental studies (Silagy Haines 1998), quantitative research is relating to numerical data analysed statistically (Muijs 2004) and qualitative research based on different methods: interview, case studies, ethnographic research and discourse analysis (Bryman Cramer 2001). Nolan and Bradley (2008) believe that the concept of Evidence based practise can bring in significant change in the delivery of health care service. It will help the entities to provide rational care planning for patients’ care delivery, aids professional to get better clinical thinking, and also contributes in choice or improvement of patients’ treatment. Randomised trial represents the best evidence in the choice of medicine and treatment (Matthews 2006). In addition to this, the proposed study will also pave the way to highlight core concerns for critical evaluation. Furthermore, the accurate statistics of errors will lead to point the core issues with the aid of government. Conclusion; precisely, although the benefits of medications when used properly cannot be under estimated but the control of resources will grant the improvement in all the other sectors directly and indirectly. Evidence based training with the utilization of proposed strategy will support the authorities to raise the potential of professional staff by rendering compact training with plans based on rationale of evidences. A thorough education of policies and procedures along with the training sessions in support of new practices induced via evidence based evaluation will aid the health care authorities to attain an improved level of control on health care delivery. Hitherto, a mutually cooperative exercise will not only aid the socio economic structure but will further improve the system by contracting the space for illegal practices. References; (OIG), U. D. (2008). Annual Performance report. US: Denial R. Levinson. A, S. C. (1998). Evidence Based Practice in Primary Care British Medical Journal . agency, N. P. (2007). Prevention and Control Healthcare Associated Infections NHS . Bourn. (2000). The Management and Control of Hospital Acquired infection in Acute NHS Trust in England National Audit Office. BR, s. L. (1996). Evidence-Based Medicine: How to practice and teach EBM Churchill Livingstone . C, M. (1997). Infection Control Hospital and Community Stanley Thorns . C, T. M. (2000). 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