Fair Competition In Health Care Essay

The Roaring Fork Valley Physicians, IPA, Inc., a Corporation adopted the unfair method of competition by determining fixing price agreement for the healthcare services provided by the doctors who are the members of

On April seventh of this year, the California health marketplace announced they would began to reform its contracts with insurers. They plan on applying quality and cost standards on health plans, hospitals, and doctors. Over seven years, Covered California, the name of the exchange, will evaluate poor performing health care providers that do not meet standard core measures, overcharging for services, and other quality metrics. If the health care providers fail to meet these standards, they could have their payments docked at least six percent and/or dropped from the network. If standards are met or exceeded, bonuses would be given. Opponents to the new reform caution that such harsh treatment could lead to a

The purpose of the coursework is to undertake a critical analysis and an assessment of the level of competition in the insurance industry of the country of our choice. In my case, I have decided to explore the health insurance industry of the United States. One of our aims is to

Regulations that prevent insurance companies from participating in interstate commerce have caused competition to grow stagnant in the United States. This lack of competition has allowed the adoption of wasteful procedures by healthcare providers, which in turn passes the increased expenses back to the insurance companies. Therein, insurance costs increase, crippling consumer’s cash flow and quality of life. While healthcare costs continue to rise, people must scrutinize the current healthcare system.

The case of Ledina Lushko, a patient enrolled in a Blue Cross and Blue Shield of Illinois individual plan, highlights many of the issues that have plagued the United States healthcare system for some time. As an insurance plan provider, BCBS of Illinois takes pride in the health outcomes of our members and has a responsibility to contribute positively to their care. The fractured, ineffective care Mrs. Lushko received is disappointing, however, this case provides strong support for a shift in focus towards managed care and specifically, the Accountable Care Organization structure. The following details several aspects of Mrs. Lushko’s experience and how her care could have been improved by enrollment in BCBS of

The healthcare system in the United States is a system composed of many private insurance companies who act independently from one another. These companies make their money through premiums which are paid by the insured; therefore a major part of the healthcare system is privately funded. This type of market is considered to be an imperfect market because it does not meet the true requirements of a free market where there is unrestrained competition between providers. In our healthcare system there is an absence of a central agency to govern healthcare. There are multiple payers and third party insurers serving as intermediaries between financing and the delivery of healthcare. The United States has a multi-payer, heavily private system in which thousands of private insurance companies are responsible for paying some claims, while federal and state

Healthcare fraud and abuse are substantial influence related to increasing health care cost. In the face of the seriousness of fraud and abuse offenses, increasing numbers of healthcare providers is pursuing new and more lucrative procedures to build business relationships. In the aspect of following an unsafe practice in order to receive kickback is uncalled for and serves as further investigation is necessary. OIG ‘s mission is to protect the integrity of the HHS programs and the health and welfare of the people

Health and Human Services (HHS) should work with the Federal Trade Commission (FTC) to identify healthcare monopolies in small to

For the last five years of my life I have worked in the healthcare industry. One of the biggest issues plaguing our nation today has been the ever rising cost of health care. If we don't get costs under control, we risk losing the entire system, as well as potentially crippling our economy. For the sake of our future, we must find a way to lower the cost of health care in this nation.

The external stakeholders are the community, patients, MedKey System members, CMS, HMOs (ie. Blue Cross Blue Shield and Tri-Care), and any other private insurances (Richards & Slovensky, 2004). Medicare reimbursement in Alabama was the lowest rate in the nation. This was a constant struggle for the hospital administrators to try to operate on such low reimbursements for their services, which is a threat. Eighty percent of patients were Medicare or Blue Cross in which there was difficulty-negotiating prices with Blue Cross due to monopoly. Buyers have high bargaining power as reimbursements rates are low from Medicare and Blue Cross held monopoly in the services area so negotiating prices was difficult. Suppliers have lower bargaining power due to low Medicare reimbursements and difficulty negotiating prices with Blue

A little over five years ago, President Barack Obama signed into law the Patient Protection and Affordable Care Act. This was a huge win for the Democratic party, after failing to successfully reform healthcare during the Clinton Administration. The vast majority of the focus on the bill went to the major provisions. However, the seldom mentioned COOP program began to make headlines this year. This program allowed for the creation of state and region-wide health insurance cooperatives. These co-ops were to be owned and run by its stakeholders with the intention of providing quality insurance at a more affordable price. Originally designed to be a replacement for the polarizing public option, nearly half of the co-ops in the program failed in quick succession. There were two primary causes. From the start the program was fundamentally flawed and the funding that the co-ops were promised simply did not materialize. This leaves Democratic leaders at a crossroads. They can either fight to fix and save the program, or scrap it and look for something better. Without intervention, the COOP program will continue to deteriorate and consumers could be hurt. It is vital that the right lessons are learned from the COOP experiment.

Health care spending in the United States of America as a percentage of the economy has reached astonishing heights, equating to 17.7 percent. This number is shocking when compared to other counties; in Australia health care is 8.9 percent, in United Kingdom 9.4 percent, in Canada 11.2 percent. If the American health care system were to hypothetically become its own economy, it would be the fifth-largest in the world. While these statistics sound troubling, they lead us to look for answers about the problems surrounding our system. The first health insurance company was created in the 1930s to give all American families an equal opportunity for hospital care and eventually led to a nationwide economic and social controversy that erupted in the 1990s and continued to be shaped by the government, insurance companies, doctors, and American citizens. In this paper, I will go in to detail about the various opinions regarding the controversy, the history behind health insurance companies, and the main dilemmas brought out by the health care crisis. Greedy insurance companies combined with high costs of doctor visits and pharmaceutical drugs or the inefficient hospitals all over America can only describe the beginning to this in depth crisis. Recently, the United States health care industry has become know for the outrageous costs of insurance models, developments of various social and health services programs, and the frequent changes in medicinal technology.

The concept of providing basic healthcare services to individuals in need has undergone an agonizing transition, from a luxury once only afforded by the affluent to a basic human right granted to citizens of every economic station, and the recently enacted Affordable Care Act (ACA) was designed to finalize this ethical evolution. Reflecting perhaps the bitter political enmity currently consuming the nation's once cherished democratic process, Republican legislatures in states throughout the union have bristled at the ACA's primary provisions, threatening all manner of procedural protestation as they attempt to delay and derail the bill's eventual implementation. One of the most intriguing aspects of the sprawling, thousand page law, however, has been the stipulation that individual states will be given a choice to either accept federal funding to expand their statewide Medicaid roster, or to forfeit all federal funding for that program in perpetuity. The role of government in monitoring and regulating the healthcare industry has been long debated, and the bitterly contested passage of President Obama's ACA, a law aimed at revising the country's health insurance system through the creating of a federal health insurance exchange to facilitate increased competition among insurers, has rekindled the debate over who holds the ultimate responsibility for regulating the care provided by hospitals, community clinics, and private practices.

Antitrust law in the United States is a collection of federal and state government laws regulating the conduct and organization of business corporations with the intent to promote fair competition in an open-market economy for the benefit of the public. Congress passed the first antitrust statute, the Sherman Antitrust Act, in 1890 in response to the public outrage toward big business. In 1914, Congress passed two additional antitrust laws: the Federal Trade Commission Act and the Clayton Act. (The Antitrust Laws. Web.)

"People have been brought up to believe that health care is an entitlement," says (Jeanne Holland, executive director of Northeast Physicians-Hospital Organization) at Beverly Hospital. "They think 'Life, liberty, the pursuit of happiness and health care on demand. ' Consumers need to change their thinking."