Essentials Of Managed Care Su20 B Section D01 Discuss
Ha3120d Essentials Of Managed Care Su20 B Section D01discussion 3
Ha3120d Essentials Of Managed Care Su20 B Section D01discussion 3
HA3120D - Essentials of Managed Care SU20 B - Section D01 Discussion 3.2: Misuse or Over-Use From your experience with hospitals or medical offices and/or from your readings/research: .Discuss where you have seen tendencies for misuse or over-use of resources. For example, whether the hospital or medical office tended to hoard certain kinds of supplies. .Consider also whether utilization review may go overboard in its oversight of resource use. Please cite references in your post which should be words
Paper For Above instruction
Introduction
Managed care aims to optimize healthcare delivery through efficient resource utilization, cost containment, and quality assurance. However, despite its intentions, issues such as resource misuse and over-utilization often emerge in healthcare settings. These tendencies not only inflate costs but may also compromise patient care quality. This paper examines instances of resource misuse and over-utilization observed in hospitals and medical offices, alongside the role of utilization review processes in controlling resource use.
Misuse and Over-Use of Resources in Healthcare Settings
In numerous healthcare facilities, there are observable tendencies toward over-utilization of resources. One common example is the excessive ordering of diagnostic tests, such as laboratory panels and imaging procedures, often driven by defensive medicine practices or financial incentives. For instance, a study by Studdert et al. (2005) identified that physicians sometimes order unnecessary tests to avoid malpractice litigation or to meet perceived patient expectations, leading to increased costs and potential patient harm from unnecessary procedures.
Additionally, hospitals occasionally hoard supplies, including pharmaceuticals, disposable medical equipment, and even basic consumables like gloves and gowns. Such hoarding can stem from fears of supply shortages or logistical inefficiencies. A report by the Government Accountability Office (GAO, 2012) highlighted that inventory mismanagement, including overstocking, leads to waste due to expired supplies and tied-up capital, emphasizing inefficient resource management.
Over-utilization is also evident in inpatient settings where unnecessary admissions or extended hospital stays occur. Hospitals sometimes admit borderline cases primarily to utilize available beds or meet financial targets, which can extend resource consumption unnecessarily. Similarly, unnecessary use of intensive care units (ICUs) has been documented, where patients initially could be managed in less resource-intensive settings (Kohn et al., 2000).
Role of Utilization Review and Its Potential for Overreach
Utilization review (UR) processes are designed to oversee and evaluate the necessity, appropriateness, and efficiency of healthcare services. While UR is valuable for controlling costs and preventing unnecessary treatments, it can sometimes overreach, leading to delays in care or denial of necessary services. For example, aggressive UR practices may result in under-utilization of warranted care if providers or patients perceive reviews as obstructive or punitive.
A study by Margolis et al. (2015) notes that in some cases, utilization review becomes overly restrictive, discouraging appropriate medical interventions through overly stringent criteria. Such overreach can lead to patient dissatisfaction, poorer health outcomes, and increased long-term costs due to delayed or inadequate treatment. Furthermore, overly bureaucratic UR procedures can divert resources from direct patient care toward administrative activities, thus defeating the goals of efficiency and quality improvement.
On the other hand, when balanced appropriately, utilization review can promote necessary resource conservation and prevent waste. Technologies like electronic health records and predictive analytics can support more precise review processes, reducing the likelihood of overreach while maintaining oversight.
Conclusion
Healthcare organizations often face challenges related to the misuse and over-use of resources. These include unnecessary diagnostic testing, supply hoarding, and inefficient hospital admissions. While utilization review is a crucial mechanism for overseeing resource use, overreach can hinder timely and appropriate care. A balanced approach leveraging technology and continuous professional education can help minimize these issues, ensuring resource utilization aligns with patient needs and system sustainability.
References
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To Err is Human: Building a Safer Health System. National Academies Press.
Margolis, J., Jiang, Y., & Zhao, X. (2015). The impact of utilization review practices on healthcare cost and quality. Journal of Health Economics, 44, 1-13.
Studdert, D. M., Mello, M. M., Sage, W. M., et al. (2005). Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA, 293(21), 2609–2617.
Government Accountability Office (GAO). (2012). Inventory Management: Key Areas of Wasted Spending and Opportunities for Improvement.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To Err is Human: Building a Safer Health System. National Academies Press.
_fact_