Question

Do you feel competition is good for health care organizations, the patients, or a combination of both? Explain why you chose your response. .

Answer 1

The competition between health plans, hospitals, and physicians competed in fifteen health care markets primarily in terms of price and, second, in network width and care. In most markets, premium prices fall (or slowly) as a result of competition. Within a plan product, competition led to similar pricing and networks and narrowed the product gap between health plans. Competition is not based on measured and informed quality of care, which limits the ability of employers and members to select health plans. As a result, there was a significant gap between the competition and the competition imagined by the architects of the controlled competition model, which is still evolving today.

Health plans and providers competed in several areas of nonprofit care, including customer choice, accessibility, style of care, and technical standards of care. Customer choice focuses on the width of the network, while access includes distance to doctor or hospital facilities and the ability to schedule appointments when needed. Styles of care include interrelationships (including the nature of interactions between enrollment, medical and non-medical personnel) and men's activities (such as the facility environment and the quality of hospital food). Technical quality of care includes how care is delivered or aspects of the care process (such as whether appropriate tests or procedures have been performed), as well as the enrollee's health status or the outcome of care, such as death or illness . , Disability, restlessness, dissatisfaction.

Not surprisingly, competition does not progress as fast in the model of the "pure" controlled competition model. The speed of progress towards that system or any other competitive system cannot be predicted given the amount of change that is taking place. We do not know how buyers are demanding valid, understandable and informed measures of health outcomes that reflect key dimensions of quality of care. In the current political climate, it is doubtful that the Health Care Financing Administration will take the initiative to push the boundaries of health care measurement and reporting. Furthermore, it is not clear what motivates employers to demand adequate competence in terms of quality, so an informed selection of employers and employees can be made on that basis. As Robert Evans observed years ago, unlike competition in all other aspects of the regulated care system, there is no direct competition among health plan sponsors to run their operations. [11] As a result, in an era of less government, the social responsibility of employers and social alliances (public and private) increases, as the cooperation of buyers plays a crucial role in determining the nature of competition and the Quality of the medical attention. , Any health system is emerging.