Power Dynamics between Health Insurer and Its Service Providers - Essay Example

Power Dynamics between Health Insurer and Its Service Providers Power dynamics between health insurer and its service providers regarding to service provision Research questions Make a discussion on what do the terms “power dynamics”, “health insurer” and “service providers” mean? What is the relation between health insurers and service providers and theories behind the two parties? What power dynamics arises between the service providers and health insurer? The main reason for choosing the research question is because they consider each player individually, that is the insurance company, the hospitals and clinics who are the insurance providers and the members who receive the insurance services. The paper then goes further to correlate the three parties so as to get the power dynamics that arises between them; this makes the research question helpful to readers since they give a preview of what the paper is about. Literature review The proposed research focuses on the power dynamics that arises between the health insurers and the service providers, whereby the power dynamics is the interplays between the insurance company and the health care providers regarding to the provision of services. Supply-Chain principles Health providers may not concur with the providers regarding to the supply of the insurance policies, whereby, the insured person may require more than what the insurance provider is offering leading to supply-chain disagreements. Relationship Marketing The insurers may need to market their products through the providers since the providers are in direct contact with patients who need the insurance policies. This implies that each party has its catch and if they disagree in marketing their policies, there may be power dynamics between the insurers who are marketing their product and the providers who are the pathway for the marketing. Studies on private healthcare provision Power dynamics entails the relationship between the insurers and providers in terms of the services provided to the members conducting studies regarding to healthcare provision is important so as to link the insurers and the patients. According to the study by Booth, Colomb & Williams (2008; pp. 66), the power dynamics in this case can be correlated to previous theories including the relationship marketing. This is because each party plays a vital role in ensuring that the members receive quality services, especially from the service providers who are the hospitals and clinics. The research focuses on the health insurers, who are the insurance companies, and the service providers who are clinics and hospitals which are in contact with the health insurers to provide the insured members with health care services, including treatment in hospitals and other services provided for in the insurance policy of members. Theoretical framework In regard to previous research work of Goddard & Melville (2001; pp.23), there are many theories relating to the subject matter. In regard to the current research, the power dynamics that arise between the two parties regarding to the provision of services may arise as a result of different preferences including marketing preferences where different patients prefer different insurance policies from different insurance companies, while most providers do not approve the use of some insurance policies. This implies that members do not get services in hospitals and clinics which do not approve the insurance policies of the patients. In the earlier research work by Angrosino (2007; pp.123), the power dynamics between the insurance company and the hospitals may arise as a result of evaluation of alternatives in terms preference of insurance policies between members and the insurance providers. The clinical services of patients are usually under threat since they are unable to access the required services accordingly in case of rooming power dynamics between health insurers and providers. The proposed research considers competition as a key player in creating these power dynamics between the two parties whereby, the nature of competition between the two parties leading to the creation of power dynamics depends on the influence of each party. This implies that a health care provider does not necessarily have to offer services to any insured member; rather the providers have to be in cooperation with the insurance company. There is a considerable relation between the proposed research and an earlier research by Hucker (2001; pp. 34) whereby the researcher explains that providers may refuse to administer health care services to members. This rises from lack of cooperation between hospitals and the insurance companies. This implies that the insurance company’s policy does not have support from the hospitals leading to the creation of power dynamics. The current research proposal gathers more weight than the previous theories because they do not give a clear justification. This is because the current study explains the existence of market oriented theories that determine the relationship between health care providers and the insurance providers. Whereby, the insurance company should first establish a business relationship with hospitals and clinics, before marketing their insurance policies to ensure that members receive health care services at any hospital using their insurance policies, this theory makes the current proposal weighty. Interviewing the two parties helps gather first hand information regarding to how the service providers and the insurance companies relate, hence, it helps in determining the power dynamics arising between the two. Research methodology The research will entail the use of observational research, whereby, there will be a case study, ethological studies and ethnographic studies. There methods will entail extensive note taking on the basis of observations and conducting an interview. The interview will be between the researcher and the insurance companies to understand their relationship they have with providers, and then conduct an interview with providers to understand their views regarding to the insurance policies that patients hold. The proposal also entails observation research, since it is more qualitative; a researcher observes the undertakings of the insurance companies and the service providers who are the hospitals and clinics to come up with the power dynamics. To achieve this, there is the collection of empirical data through semi-structured interviews. This research method is efficient in reference to previous research by Dewalt & Dewalt (2002; pp. 35) where the method of observational research was in use rather than combining the two methods. Rather, the research involves two parties, which are the insurance companies and the service providers. This explains why use of true experiment as a research method is not necessary in this research since there are no variables to experiment on; rather, there are two parties. This explains further why sampling would not be significant in this research. This is because there being only two parties involved while sampling entails use of many subjects so as to make individual sample. In the investigation of the power dynamics, it is vital for researchers to ensure that there is no ambiguity in the research method, there is clear stipulation on the steps in consideration by identifying the various parties who give rise to the power dynamics (Panneerselvam, 2004; pp 90). Secondly, use of semi-structured interviews would give the necessary information and data which are necessary to make comparisons. Finally, the data get consideration separately so as to understand the conflicting ideologies. Previous theories including the S-D logic are irrelevant in this research. This is because the theory does do not clearly stipulate the actual reasons that lead to the existence of power dynamics between the insurance companies and the service providers. Data analysis and findings From the study, it clear that there are potential dynamics arising between providers and insurance companies in terms of the service provided. The findings in the study are that some providers may refuse to offer services to patients who hold some insurance policies. On the other hand, some insurance company do not recognise some service providers as legitimate and, thus, members who seek health care services in the facilities do not get compensation. These findings are according to the research work of Sultz & Young (2009; pp. 43) who claim that 60 percent of the insurance companies do not compensate their members who seek health care services in some clinics and hospitals which do not have recognition from the insurance company. On the other side, 40 percent of service providers do not offer health care services to members who do not possess the policies from some companies. These differences in opinion coincidently lead to power dynamics between the insurance companies and the service providers. Potential, practical and empirical obstacles To get exact deductions from a research study in regard to the work of Kumar (2005; pp.67), there is the need to obtain actual information from the actual subjects. In the process of obtaining the data which will arise from the interviews and observation, there are obstacles that are practical and others empirical. The practical obstacles include lack of access to vital information, which presupposes insurance, records to know the number of insurers and the number of service providers; this information is crucial for the research in order to deduce a ratio for rating the power dynamics between the two parties. Empirical obstacles may arise during the study whereby the information necessary could be password protected. Accessing the information would, hence, be almost impossible. Health insurers are secretive people; this is to avoid exposure of vital information regarding to the operations of the firm due to competition from other firms (Goddard & Melville, 2001; pp.109). Most information which would be helpful in the research work would be inform of codes such that only the relevant parties within the insurance firm can access the information. This would amount to practical obstacles as being a mere researcher; it is hard to remove the code so as to use the information. Seeking the help of an expert to retrieve the information would come with its difficulties. Conceptual and theoretical problems and difficulties The research method under consideration is observational research; this implies that the researcher has to interview the health insurers and the service providers. According to Kothari (2005; pp. 56), conducting oral interviews is sometimes challenging due to the many obstacles that come with it including lack of correspondence of the interviewees. Whereby, they are not willing to give out vital information regarding to the research topic; this makes it difficult for the interviewer since one cannot get information from a person without their consent. Secondly, biasness may arise considering the health insurers may give information which is unreal to avoid incrimination or hide information for no good reason. This makes the information or data taken to be contradictory and the final deductions do not correspond to the desired aim of the study. During the study, a researcher may experience theoretical problems. These problems include exaggeration of information, whereby the interviewees who are either health insurer or service providers exaggerate information so as to outdo the other party. These conceptual and theoretical problems, according to Sultz & Young (2009; pp. 89), may make the information lose its means and consequently lose its intended purpose. Getting individuals who have the will to share information is a difficult task. Ethics To get the best from an observational or correlation research, there is a need to demonstrate enviable ethical characteristics. Ethics may vary from conducting oneself during the research and in presenting the final data as seen in the work of Jones (2006; pp. 21). Ethics to incorporate in a research work is personal ethics, which includes use, of polite language during interviewees. This will enable the correspondent to feel comfortable and give out the necessary information without fear or favour; this ethic is crucial, especially when dealing with uncooperative correspondents. It is ethical for a researcher to ensure that they do not force information out of an individual; this may be through the use of incentives such as money so as to get information from an interviewee. Using incentives to get information from an individual is not just unethical but it is unprofessional (Stahl, 2004; pp. 89). Correspondent to the research process may give wrong information so as to get the incentive on offer; this would corrupt the purpose of the research. According to Lusch & Vargo (2006; pp. 78), in case a researcher comes across an individual who tries to ask for incentives, hence, compromising the ethics of the researcher, it is vital to either report the person to the relevant authority or not consider getting the necessary information from them. Position of a researcher in a political field When doing a research in a political environment, it is essential for the researcher to practice altruistic, ethical skills. Politicians are influential people who may use all ways to ensure that their agenda gets manifested on the people. As a researcher, the main aim is to gather first-hand information from the study rather than gathering information which is not incisive. The position of a researcher in such a situation, according to Escobar, Griffin & Shaw (2010; 99), is to demonstrate professionalism by ensuring that the political entities do not interfere with the data or information required to make a concrete conclusion. This implies that the position of the researcher is neutral, as there is no favoured party. Political influence has a positive and negative impact of the study. On a negative aspect, influence by politicians would interfere with the information in use and make it difficult to establish the main goal of the research. Politicians may use incentives so that a researcher issues deductions that favour the politician’s ambitions. On a rather positive note, doing research in a politically infested environment would imply that the data are more admissible since there is political influence (Zweifel, 2007; pp. 51). Interviewing a politician would come handy in establishing a favourable ground for enviable deductions since people consider the ideas from politicians as being supreme. Timetable First week, day 1: conduct a reconnaissance on the place to conduct research. First week, day 2: prepare the research questions and prepare questionnaire s for the research First week, day 3: take a two day rest to stimulate the mind in preparation of the research work Second week, day 1: acquire the necessary materials for the work, like recorders. Second week, day 2: get authorization from the relevant authority. Second week, day 3 and 4: conduct interviews and observations. Second week, day 5: write a research proposal using the available data. Third week, day 1: make a presentation to the instructor for approval. References Angrosino, M. V. (2007). Doing ethnographic and observational research. London: SAGE Publications. Booth, W. C., Colomb, G. G., & Williams, J. M. (2008). The craft of research. Chicago [u.a.], Univ. of Chicago Press. Dewalt, K. M., & Dewalt, B. R. (2002). Participant observation: A guide for fieldworkers. Walnut Creek, CA: AltaMira Press. Escobar, M.-L., Griffin, C. C., & Shaw, R. P. (2010). Impact of health insurance in low- and middle-income countries. Washington, D.C., Brookings Institution Press. Goddard, W., & Melville, S. (2001). Research methodology: an introduction. Lansdowne: Juta. Halperin, S., & Heath, O. (2011). Researching politics: methods and practical skills. Oxford: Oxford University Press. Hucker, K. (2001). Research methods in health, care and early years. Oxford: Heinemann. Jones, A. M. (2006). The Elgar companion to health economics. Cheltenham [u.a.]: Elgar. Kothari, C. R. (2005). Research methodology: methods & techniques. New Delhi: New Age International (P) Ltd. Kumar, R. (2005). Research methodology: a step-by-step guide for beginners. London [u.a.]: Sage. Lusch, R. F., & Vargo, S. L. (2006). The service-dominant logic of marketing: dialog, debate, and directions. Armonk (N.Y.), M.E. Sharpe. Panneerselvam, R. (2004). Research methodology. New Delhi: Prentice-Hall of India. Pratt, B., & Loizos, P. (2002). Choosing research methods: data collection for development workers. Oxford: Oxfam. Silverman, D. (2010). Doing qualitative research: a practical handbook. Los Angeles, CA: Sage. Stahl, M. J. (2004). Encyclopaedia of health care management. Thousand Oaks, CA: Sage. Sultz, H. A., & Young, K. M. (2009). Health care USA: understanding its organization and delivery. Sudbury, Mass: Jones and Bartlett Publishers. Zweifel, P. (2007). The Theory Of Social Health Insurance. Boston [u.a.]: Now. Read More