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Narrow Health Networks Essay

Introduction

Public policy analysis is a process that is concerned with the outcome of heath policies. It focuses on the effects of health policies and on the people in a society. Public policy focuses on both positive and negative effects of health care on a consumer. It gives a systematic evaluation of policies and provides recommendations thus giving consumers a variety of choices and right to enjoy their preferred health care service. This paper seeks to discuss problems related with health financing policies. It discusses the set of health financing policies and gives a solution to the problems.

Executive Summary

Health care costs have risen significantly in the last 10 years. As a result, this has drastically affected the quality and access to medical care. Health care financing reforms have been greatly hindered by poor insurance policies and failure by the government to pay uninsured medical care services. This has led to the increase in cost of health care services. The government, therefore, needs to establish well-guided policies on health care insurance and develop a well-designed program for uninsured health care services.

Problem Statement

The problem that this research paper is concerned with is on options in health care insurance, health providers to the patients to enable participation in the expansion of narrow health networks.

Literature Review

Health care insurance companies in the recent years established work with a new strategy to cover health care costs. This new strategy aims to reduce the cost of health care and the premiums. This strategy method of working is seeking health care providers that offer health care to individuals under their health insurance with meeting their requirements.

Policy Options

Private insurance is another insurance policy that covers costs of medical treatment. Private insurance involves private companies that offer insurance services. Due to environmental and economic changes, private health insurance companies have recently designed and implemented new strategies to cover health care costs (Porter et al, 2005). The aim of these new strategies is to reduce the cost of health care. The strategy involves seeking health care from specific care providers for individuals under their health insurance that meets their requirements. It helps to reduce cost of health care as well as premiums. The economic dynamics in health care have forced insurance providers to seek for lower health care costs.
Private insurance companies have adapted narrow health networks (Whitehead et al, 2001). This is the process that further subdivides the company into smaller networks that target specific health care providers. For example, dental insurance: it enhances protection of policy holders and covers reduced medical cost.

On the other hand, citizens have the option of receiving insurance policies from the government. Health insurance can be easily provided to the citizens by the government through taxation of employees. The health insurance policy then can be offered as part of an employee’s benefit (Whitehead et al, 2001). The provision of insurance services is vital to employees as they work diligently to get it. The employees have the privilege to choose their preferred health care provider, especially one with quality services as well as the one who is close to their homesteads. This form of insurance is significant as it provides broad access, so that all citizens can enjoy proper health care from any physician or hospital. However, with the changing economic trends, there is a need to provide employees with the best and cost-effective health care.

The health insurance policies need to provide choice of quality health care (Porter et al, 2005. The citizens of a society understand the importance of their need and right to access a physician from their location and whom they can trust to provide them with the quality health care. This is because a citizen is the one to receive treatment. They need not to get tired, incur loss of time and high cost of transport to access health care services.
Insurance company that allows a range of choices in health care providers promotes improved health care sector. Also, it creates the opportunity for expanding quality of health care among its providers. In addition, it encourages provision of improved technology of software that allows for quick data collection and exchange of information among health care givers. Thus, this facilitates consumers to access health care faster without wasting a lot of time (Whitehead et al, 2001). The heath care insurance policies should thus provide consumers with several options of providers and services. This helps the consumers of insurance policies appreciate and enjoy their right to make decisions about their health care.

Consumers of health insurance services should be able to make a choice in the cost of health care. This is not an easy option to the insurance service providers. This is because cost is a matter that involves numerous parties, thus negotiation is difficult. Most insurance givers have hard time to reconcile the decision on cost to satisfy the parties involved due to the existing economic status. They are in quest of a chance whereby they can ensure that they pay less for a health service of their consumer. Nonetheless, a large group of insurance consumers is seeking for the autonomy of choice of cost in a health care service. They are willing to pay more to ensure high quality services in the health care they receive (Whitehead et al, 2001) .

Undoubtedly, it is more vital now for the insurance service providers and health care providers to design a better, flexible, and vivid system of health care. A well-planned health care with directives to insurance consumers can aid in conveying quality health care delivery and cost to a considerable size. Obtaining consumer views on different types of insurance may also assist in developing insurance policies, especially in the cost options (Porter et al, 2005).

Cost optional insurance policies can be very beneficial to consumers in the present economic times. It would especially make an economic difference in instances, where consumers enjoy low costs without reducing quality of health care services. Reforms of insurance policies to promote efficient insurance programs should be designed and implemented (Szreter et al, 2004). The insurances should also be cost effective to encourage and increase the number of consumers. This will encourage uninsured people to apply for insurance services. As a result, insurances will promote better and cost effective health care.

 

Policy Reforms

In order to promote quality and successful insurance programs, health care reforms are vital (Starfield et al, 2005). The reforms need to be made by the federal government. Rules grounded on the Patient Protection and Affordable Care Act need to be formulated and implemented. The rules should comprise stark laws, medical liability, Civil Monetary Penalties Law, essential health benefits and health reforms. The stark laws should be designed to protect consumers against insurance policies in case medical physician is involved.

Insurance reform policies thus promote medical reliability (Porter et al, 2005). It gives an assurance that health costs decrease but not at the price of quality health care. The insurance thus gives assurance, therefore guarantees even dynamic increase in health costs. Civil Monetary Penalties Law prevents direct payment, which may lead to the limited services to consumers of insurance services. This is intended to thwart incentives issued to the medical physicians that disregard regulations of their professionalism. The state legislature reform is portrayed by vague demand by a government insurance commissioner who demands that all health plans must have a network, in which they are to operate to provide insurance service to society. The insurance services must meet these regulatory requirements to ensure their success in providing quality health care (Szreter et al, 2004).

Narrow networks in insurance have advantages as it enables the setting up of patient medical homes (Swan, 2009). This mainly meant for patients with chronic illnesses such as hypertension, osteoarthritis, cancer, diabetes, coronary artery and chronic disease, kidney disease. This special narrow network has been established by Blue Shield, an insurance company in Californian and their main objective is to grant better medical cover at the lowest cost for individuals. According to Szreter et al, (2004) the patients in Patient Centered homes can access their information with simplicity due to the existence of an advanced-access component. This component is then used to show how the narrow networks help the physicians of the problem of sourcing for patient information in settings such as the emergency room (Starfield et al, 2005).

There are however even narrower networks that comprise provision of specific health care plans to certain employers by large hospital systems for specific health care employees (Swan, 2009) . Such specific health care services consist of the costly and rare surgeries such as cardio and neurosurgery while achieving the desired goals of high quality services at low cost.

These narrow networks have however some disadvantages. First they lead to raise rules and regulations concerning the manner in which health insurance companies control cost. This could lead to customer complaints on their medical physicians and hospitals (Swan, 2009). Furthermore, most people do not understand what is entailed in these narrow health networks and why they are in place. These narrow networks therefore, can only exist suitably in areas where high quality health services offered in a variety for this reason an area with competition. Thus creating the need for a competitive market to ensure that the costs are always low as contrasted to a market with monopoly and this also creates a room for innovation.

Political, Legal & Environment Factors

Heath financing policies are fragmented by nature (Starfield et al, 2005). Under the constitution, it is the responsibility of the states to regulate health care financing policies. The regulation of health care financing policies is not integrated and does not fully incorporate major professionals. The government participates in promoting quality health care services by setting laws and regulations, which players in health care services must adhere to. Also, the government intervenes in the health care to help set standard in provision of health care services.

Economic Factors

Changes in the economic trends, such as price, consumer tastes, and preferences are inevitable in health care financing. According to Starfield et al, (2005) the cost of production changes over time and there is the need to evaluate the likelihood of price fluctuations in the future. In addition, the price set determined by the government through fiscal and monetary policies influences the cost of health care services. Competitors and suppliers’ prices that influence the market in health care services. Fluctuations in foreign currencies, especially the US dollar, also have impact on the services. The introduction of taxes on uninsured medical care in the industry is also the government’s initiative to finance health care. This means that health care services have to continue forecasting economic trends to predict price changes in the health care services and products so as to adjust prices accordingly (Swan, 2009).

Socio-cultural Factors

Culture helps to identify behavior of groups of people. It displays the unique pattern of life in societies. People with similar culture always have their own values, beliefs and customs that bring them together as a society. Health care service providers are required to conduct their operations in a socially responsible manner (Starfield et al, 2005). Indeed, the way health care services are provided in different market segments is guided by socio-cultural factors. These may depend on the different factors, such as religion, disability, race, gender, political activity, and personal association among other social aspects when offering services. These aspects guide the provision of health care services thus influencing the health care finance policies.

Technological factors

Currently the health care service relies on the technology to run operations across the country. Technology continues to change and this is a challenge to financing health care (Szreter et al, 2004) . Health care services need to try to cope up with the speed of technological change for them to remain relevant in the market. The services use new technologies to provide quality health care that satisfies customer needs, thus having a competitive advantage over its competitors on the global scene (Swan, 2009). Normally, technology influences the type of equipment and machinery used to offer medical services, as well as the operations needed to run health care services.

Evaluation

Narrow insurance networks need to be constantly evaluated (Starfield et al, 2005). They should be observed if they have various impacts. This can be done by conducting interviews in different hospitals and with different medical physicians and pharmaceuticals to assess the impact and success of insurance to promote health care. As for the hospitals, those outside the network will experience low profits and a drop in the volume of patients. Those hospitals with diminished profit margins will need to cut-off staff so as to meet costs of running in a bid to remain in the market a little longer. Hospitals in the network are to experience larger market hence high profit margins, so no need to diminish infrastructure costs. All these will result to a subsequent greater incentive for alignment and efficiency, as it was earlier said that hospitals and insurers needed the payer-provider alignment for narrow networks to thrive.

In order to promote success of the insurance networks, a no of evaluations and measures are required including the setting up of health net data (Starfield et al, 2005). Health net data is destined to evaluate and identify from a number of health care providers to determine who provides the best quality services at the lowest possible cost. The health net data has a chief objective, which is value for money for the consumers. In most regions, the health net data brings a variety of specialist and physicians for the employers from hospitals providing quality at low cost. The health net data provides a reliable source of reference for the employers where they can infer the credibility of the narrow networks of these providers for future references. The health net data is an example of a population health tool which provides clinical data at the point of care to improve decision making as well as support the creation and management of health care plans (Starfield et al, 2005).

Another factor that requires evaluation in narrow networks is the definition of population into specific groups (Starfield et al, 2005). For health providers to maintain the control of cost, they must keep patients within a defined network in the health industry. Within these defined networks, it is unproblematic for providers to manage patient information and data in addition to define outcomes across all the participating insurance providers. The use of specific providers is very imperative largely because of the ability of the provider to control costs.

Conclusion

The overall effect of narrow networks on insurance is creation of narrow insurance networks. Here the main objective to control costs should be assessed. The consumers are encouraged to use certain insurance policies that offer low medical care.

The strategy of narrowing healthcare network in insurance of health care is not an easy (Starfield et al, 2005). It is a matter of issue that reveals and deals with numerous stakeholders, thus negotiation is always essential. Insurance providers have tough time to reconcile to the decision, where there is a satisfaction for the parties involved because of the present status of economy. They are seeking for a chance that makes them pay less.

However, a large number of insured people are looking for the freedom of choice among health care providers. They are going to be willing to pay more to assure adequacy of the health care they receive. It is more serious now for insurance providers and health care providers to design out more flexible and clear method of health care. A systemized health care with instructions to individuals can bring quality health care delivery and minimize on the cost of health care to insurance service consumers (Szreter et al, 2004).

The narrow networks will have a variety of effects in different areas of health such as hospitals, pharmaceuticals and physicians in the next ten years (Starfield et al, 2005). In the hospitals, those who are outside the network will experience little profits and a decrease in the number of patients. Due to the reduced profit margins, hospitals will have to cut-off staff in order to meet costs of management in an attempt to remain longer in the market. Hospitals in the insurance network will get broader market hence a high profit margin so it will not be necessary to diminish infrastructure costs. As a result, it will lead to a subsequent better incentive for alignment and effectiveness in the hospitals and the insurer demand for payer-provider alignment for the narrow networks to prosper.

In the next 10 years insurances will ensure that in referred pharmacy networks, consumers have option to choose any pharmaceutical in the plan of their network. They pay less when their prescription full with a preferred pharmacy contrasting to when their prescription is packed with a non-preferred pharmacy that they pay more. The limited pharmacy network, consumers are constrained to particular prescription (Porter et al, 2005). Consequently, in the span of ten years from there will be superior quality in pharmaceuticals and improved revenue from strategies to increase this revenue such as promotions, marketing, and targeting disease-afflicted areas.

In duration of ten years from now, physicians will remain as the most important consultants during the referrals. In addition, physicians will acquire positions of leadership as incentives by the health insurance companies, which could be suitable for decision-making (Szreter et al, 2004). It is however, imperative to note that this applies to physicians within a network only.

In the next 10 years insurances will ensure that in referred pharmacy networks, consumers have option to choose any pharmaceutical in the plan of their network. They pay less when their prescription full with a preferred pharmacy contrasting to when their prescription is packed with a non-preferred pharmacy that they pay more. The limited pharmacy network, consumers are constrained to particular prescription. Consequently, in the span of ten years from there will be superior quality in pharmaceuticals and improved revenue from strategies to increase this revenue such as promotions, marketing, and targeting disease-afflicted areas (Starfield et al, 2005).

In duration of ten years from now, physicians will remain as the most important consultants during the referrals. In addition, physicians will acquire positions of leadership as incentives by the health insurance companies, which could be suitable for decision-making (Swan, 2009). It is however, imperative to note that this applies to physicians within a network only.

An overview on Narrow networks therefore validates the importance of insurances to the economy. It is identified as a policy to reduce the ever increasing health costs at the same time maintaining the quality of the health services provided. These narrow networks have numerous to insurance service providers and consumers. The networks should follow the stipulated laws to promote different choices of insurances to consumers (Swan, 2009). The health insurers are thus essential party as they maintain narrow networks with the major objective of lowering cost and providing quality health services.

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