HSM 546: Health Insurance and Managed Care
Week 4 assignment:
Professor: Venice Johnson-Warren
This week paper is a scenario between the ABC insurance company, The Verde Greene hospital, the employers and employees and the patients. This is quite an enough complicated case because with the good reputation of the Verde Greene hospital for quality in maternal care and cardiac rehabilitation, it would be hard to approach that kind of hospital and put it on the managed care of the ABC insurance. With its success on selling the insurance to the employers, the ABC is forced to give to the Verde Green hospital the exclusivity to maternity and cardiac care for all ABC patients in the ABC insurance. The Hospital insisted on that choice even though it would not a good idea for some patients that had to drive 50 miles and pass 4 to 5 good hospitals on their way to this particular hospital. Here are only to the patients commuting problems but also to the employee’s one. Many employees threaten not to enroll if only Greene Verde hospital has the right to treat those kinds of patients.
In this debate the principal argument is the exclusive contract between the ABC insurance and the Verde Greene hospital. In this kind of contract we could cite the notion of violating the antitrust act. In 1975 the US Supreme Court put the physicians and the healthcare system under a federal antitrust law. This act could be understood by studying the Sherman Antitrust Act that do not accepts contracts with so many limitations and restraints while trading. In other words there should not be any agreement that could imply or express anti competitive goals. Here the Verde Green hospital wants to have the exclusivity of having the maternity and cardiac care for all patients enrolled in the ABC insurance. That will imply that rule of the unique provider of obstetric and cardiology services are prohibiting to all others 13 to 14 counties. The other issue is to understand the reason of the hospital willing to hold the right to only provide the maternal and cardiac care in the all area. Is the hospital scared of competition?
The reason this is considered as unfair to all patients is because how come they had to drive this far to receives the cardiac and maternal care they want. Why do they have to drive 50 miles for cure where