RGV DHR Cardiology Insurance Problems (Business & Marketing Research Paper)

RGV DHR Cardiology Insurance Problems
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Introduction
Healthcare is one of the critical concerns permeating socio-economic and political discourse. One aspect revolving around healthcare discussion entails access to healthcare services. There is a desire to develop and increase access to comprehensive, quality, efficacious, and affordable healthcare services that maintain health, prevent diseases, reduce disabilities, and limit morbidities, mortalities, and premature deaths. Health care financing is a critical pillar of healthcare access. This paper deploys theoretical frameworks and conceptualization to explore health insurance coverage issues for cardiac treatments, diagnostic tests, and interventions in Rio Grande Valley. The field of cardiology exists in an environment that is rapidly changing. Thus, it needs to adapt and cope with contemporary issues such as health insurance financing. The critical illnesses are at cardiac practice centers, including lipid derangements, hypertension, structural heart diseases, smoking, obesity, diabetes, and stroke. These are the challenges that exacerbate cardiac problems, expanding the need for comprehensive cardiac management interventions that entail flexible healthcare financing necessary for healthcare providers such as Rio Grande Valley Cardiology and others to effectively deliver healthcare services.
Literature Review
Theoretical Conceptualization; General Systems Theory, Max Weber's Bureaucracy theory and Humans Relation Theory Underpinning Health insurance Coverage of Cardiac-related healthcare services
Healthcare delivery is not a concept the exit in isolation. Instead, it survives in an environment comprising of diverse interlinking factors. The healthcare status of any population is affected by socio-economic, political, cultural, and environmental factors. Various theories can explain the interaction between patients, healthcare providers, and health insurance firms. The human relations theory of organizations can be used as a blueprint to create fertile environments that encourage human resource engagement n promoting proper health insurance use. This theory is individual-centered, maximizes workers' productivity by taking individual traits into account, and considers the informal organizations in the workplace (Sandberg, Loacker & Alvesson, 2015). This theory can aid in the reorganization of institutional human culture encourages client-centric solutions.
The best theory that can explain the intricately connected determinants of health is System Theory, as advanced by Ludwig von Bertalanffy. The General Systems Theory emerged in the 1940s as biologist Ludwig von Bertalanffy tried to examine life or living system concepts. Ludwig von Bertalanffy postulated a General System Theory to address the phenomenon of increasingly complex global challenges.
The General System Theory became an alternative form of thinking to dominant reductionist analysis, which lacked interdependence, inter-linkages, and wholesomeness (Montuori, 2011). The concept of reductionism supported breaking a complicated matter into a simple phenomenon for an in-depth exploration. Thus, the reductionist approach deploys the idea of isolation in the conceptualization process. The phenomenon of whole or larger is absent in reductionism isolation, and this theory cannot explain interconnections among systems and open systems that underpin influences from the environment. General system theory reflects a new approach to the thought process that explains interconnections among structures or systems and accounts for the nature of open and closed systems interacting with their environments. General system theory is trans-disciplinary rather than interdisciplinary, where interdisciplinary refers to the interaction between disciplines, whereas trans-disciplinarily refers to going beyond or across disciplines. General system theory would be the common language across diverse disciplines (Montuori, 2011).
Health care financing is not a concept of reductionism. Instead, most of its aspects ought to b explained by general systems theory. Various healthcare providers such as Mcallen tx DHR cardiology face challenges in healthcare costs arising from medication, tests, and cardiac interventions. More often, patients find it difficult to settle or afford cardiac management interventions and procedures. Furthermore, insurance that covers cardiac healthcare costs is often billed more. These health financing challenges emerge from various quarters and are influence by a myriad of policies, political, legislations, laws, and economic factors. The interaction of such factors is well captured in General System's theory to explain healthcare providers' troubles, such as Mcallen tx DHR, face.
The troubles face in healthcare financing can be explained via the perceptual prism of Max Weber, who argued that bureaucracy constitutes the top-notch level of efficiency, rationality, and satisfaction. Max Weber thought bureaucracy was a logical ideology that would transform all of society. However, he did not anticipate that the bureaucratic features could lead to adverse outcomes. Formal rules and regulations nurture uniformity and predictability. Still, they are accompanied by a lot of procedures that derail the seamless flow of work amongst divisions, departments, and teams, is based on principles of bureaucracy. Bureaucracy Theory, as postulated by a German scientist, Max Weber, defined this theoretical perspective as a high structure, formalized, organized, and hierarchical structure comprising of rules, laws, regulation, and lines of authority, with remarkable specialization on labor, formalized set of rules and regulations and element of impersonality. Could Max Weber's theory explain the source of health insurance challenges in cardiology health services delivery? The intricacies and bureaucracy in the health insurance sector often lead to difficulties in settling healthcare costs.
Substantial resources healthcare costs are attributed to bureaucracies in healthcare. U.S. insurers and providers took more than $800 billion in 2017 on administration, and the average American is paying more than $2,000 annually as a result of bureaucracy (Carroll, 2020). Over one-third of all healthcare costs in the U.S. resulted from insurance company overhead costs and provider's time spent on billing. Healthcare costs in the U.S have been on the continual rise partly due to bureaucratic processes. So, why could administrative costs associated with a bureaucracy so high in the U.S? The answer is pretty straightforward. There is a tug of war between the insurance companies and health care providers. Each of the parties is trying to control the game in the system. For example, if a patient reports to the hospital due to heart failure and the condition is coded as an acute exacerbation of heart failure, the insurance reimbursement is substantially higher than if the case is coded or described only as heart failure (Carroll, 2020). This situation has led to more paperwork requirements to back each coded diagnosis, resulting in many person-hours lost in supporting each claim and billing process. The lost resources, including time and finances, could have been channeled to meet healthcare access gaps. These bureaucratic and administrative processes constitute a substantial burden to the U.S healthcare system in healthcare financing.
Bureaucracy is one of the core impediments to growth and development in the healthcare industry. It spans all healthcare spheres, including healthcare financing and health insurance coverage—bureaucracy tears down more value in health care systems. Bureaucracy is not only taking a toll on healthcare delivery but also other industries whose growth has been significantly constrained by bureaucratic-inclined administrative frameworks. Bureaucracy in health insurance is of substantial concern because it is a growing problem. It destroys critical values and practices such as those that encourage problem-solving strategies, and top-level managers are unlikely to recognize administrative, bureaucratic processes. Many health care providers delivering care to patients are often exposed to disfranchised and fragmented directives and forced to cope with the situation by providing ineffective solutions to healthcare financing related to health insurance.
Administrative and bureaucratic processes in health insurance dampen efforts aimed at improving health. However, this observation should not derail or discourage efforts to tackle such a problem. There are feasible and proven ways of managing bureaucracies by designing systems that encourage better mutual and understanding partnerships between insurance organizations and healthcare providers. Resolving issues arising from health insurance is a critical milestone in increasing access to healthcare services. Health insurance organizations in partnerships with healthcare providers need to fight administrative bureaucracies by letting every party experience daily healthcare delivery encounters. There is a nee...