How do providers influence the decisions that patients make?
Health is a sensitive matter in any part of the world. In the US, the importance of better health is reflected in the huge budgetary allocations (around 20% of the entire budget goes to health (GUWS Medical, 2015). Of course, the budgetary allocations have been increasing year in year out as a result of the push and responses from both the patients and healthcare providers respectively. However, one of the most forgotten aspects is the influence that the healthcare providers have on the choices that the patients ultimately choose or have. The Institute of Medicine in 2010 put the figure for the annual price of unnecessary medical care at $210 billion. Besides, the unaccounted underuse or inappropriate treatment for patients as a result of poor patient decisions among other factors has incessantly inflated the Nation’s health care tab.
The decisions that patients make are directly influenced by the choices availed to them by the providers or derived from the kind of advice they receive from the providers. Among the stakeholders in the healthcare system, healthcare providers are considered the most critical and they determine over 80% of what finally happens to patients. It can be seen where a patient damages his leg in a fatal accident. The patient has to choose between amputation of their legs and an option of surgery for long-term painful healing. The patient is totally dependent on the doctor to assure them which of the options is the best for the patient considering many factors that face the patient.
Although there has been debate over patient involvement in the decisions, there is still an inferiority complex among a vast section of the patients regarding healthcare/medical knowledge. Therefore, what the physicians and providers say forms the priority choice for patients. This makes the providers have a greater influence not only to the kind of decisions made by the patients but also to the larger healthcare system whose operations are primarily dependent on the providers’ choices and decisions.
As depicted above, patients would have no choice but to follow the physician’s directions. In fact, in healthcare, there is an unwritten assumption of not questioning the provider’s direction. This as a natural consequence enslaves and limits the patients to the decisions of the providers and physicians even in situations where patient choices would be vital for their survival. According to the Institute of Medicine (GUWS Medical, 2015), this situation is as a result of low health literacy. It estimates that one among ten patients across the US knowing how to manage their health adequately. As well, most patients make decisions under emotions as they need to get well soonest. This leads to costly and profound outcomes that are not limited to exposure to unnecessary health risks only.
Impact of insurance plans to doctors and patients
Managed care organization through insurance plans has been touted by many as an innovation that has improved the health care access to Americans. It is believed that the insurance plans have since their introduction seen the enrollment of more Americans into the managed care organization due to its many benefits accruing to members. It offers health care that is less expensive and thus the poor and disadvantaged can also access it (Brumley, 2002).
The system is better regulated by the government under the watchdog of civil society and should be socially responsible. The healthcare system is represented by health demanders and health suppliers; the demanders can be individuals, advocacy groups, among other interest groups whose primary motivation is to make health care affordable and available for all. The suppliers of health could be legislators, executive, judiciary, bureaucrats or private sector players dealing with health matters. The decisions that health suppliers and demanders make influence the healthcare landscape both in the short and long run.
However, the criticism points to the system as one that reduces the chances of introducing new innovative technologies restricts clinical research and interferes with physician-patient relationships. The limiting nature of the insurance plans has discouraged many members under the plan because not only does the system limit the time of hospital stays but also restrict what the physician can prescribe, it chooses a doctor for a member and a doctor might not be able to refer a patient to another specialist. This has dented the relationship between the physician and the members because the hands of a physician are tied to the system’s regulations (Choosing a Medicare managed care plan a guide for Medicare beneficiaries, 2003).
The option that members in the insurance plan have when they are denied coverage for medically necessary care is to seek private care where they will have to pay directly for the services; alternatively, they can litigate to secure the same services through their membership plan however, this option might take longer.
Regulation of physicians and patients
The regulatory environment plays a significant role for both the providers and patients. The regulatory environment is set by the legislators and other health care vital policy makers who determine the kind of insurance plans that should be rolled in the market (Longest, 2014). It is incumbent upon the regulatory environment to ensure fairness and affordability of the health care services. The price floors and ceilings determined by them either lock or opens doors for many more people to receive managed healthcare.
References
Brumley, R. (2002). Future of End-of-Life Care: The Managed Care Organization Perspective. Journal Of Palliative Medicine, 5(2), 263-270.
Guwsmedical.info,. (2015). The Demanders of Health Policies - Health Policy - GUWS Medical. Retrieved 20 June 2015, from http://www.guwsmedical.info/health-policy/the-demanders-of-health-policies.html
Longest, B. (2014). Health Policymaking in the United States (5th ed.). Chicago: Health Administration Press.
