I. You are an economist working for a large health insurer. The CEO of the health insurer calls you into her office one day and says she concerned about rising health care spending. She says hip and knee replacements are the most common inpatient surgery for elderly adults and can require lengthy recovery and rehabilitation periods. Right now, when one of the enrollees (e.g., one the people who has a health insurance plan through the insurer where you work) has a hip or knee replacement, the health insurer pays the providers involved in these episodes of care — hospitals, physicians, and post-acute care providers — separately. Each provider is paid an administratively-determined fee for the care provided (e.g. the hospital gets one payment, the orthopedic surgeon gets another payment, and the post-acute care providers receive a third payment).
The CEO says she’s heard that this way of paying providers for hip and knee replacements is contributing to wasteful spending. She asks if this is true. a. Explain the payment system currently being used for joint replacement, and why it is contributing to wasteful spending. b. From an economic perspective, is the quantity of joint replacement surgeries provided to your elderly members too high, optimal, or too low, and why? Is the quality of care in joint replacement surgeries too high, optimal, or too low, and why?
2. The CEO is thinking about changing payment for joint replacement surgery to a single payment for patient episode of care that begins with admission to a hospital for a joint replacement procedure and ends 90 days post-discharge. This “bundled payment” (also can be called a “case rate”) is to cover all medical services provided to the patient related to the joint replacement procedure.
a. If the health insurer started paying for joint replacements using bundled payments, how would the quantity and quality of procedures change from your answer above and why? b. What do you expect would be the impact on spending on joint replacement surgeries? c. Are there adverse consequences of paying for joint replacement episodes using bundled payment that you think the CEO should worry about? What are they, and how would you determine whether they were occurring?
3. The CEO then asks your advice about moving towards bundled payment more generally. What types of medical care and cases do you recommend for bundled payment? Can you describe a rule of thumb? Something qualitative like: We should use bundled payment where is large and is small.
Identity or identity characteristics are the premise of what makes a man their identity. At the point when communicated steadily that is valuable to a man, they are depicted as "a continuing example of our contemplations, sentiments, and practices. They are the way we think, feel, decide, and take activities" (Barker, 1995). They are resolved both by a man's hereditary cosmetics and natural factors and are a deciding variable with reference to how a man carries on with their life. At the point when an identity quality winds up inflexible and useless, where it essentially prevents sound considerations and exercises and damages the individual who has them, this might be the reason for an identity issue. As per the DSM-IV an identity issue must demonstrate an "enduring example of conduct and inward experience that extraordinarily goes astray from standards of the individual's way of life" (James Morrison, 2006). This could incorporate identity designs that are typical in a few people, yet are misrepresented or highlighted in those with an identity issue. All together for a man to be determined to have an identity issue, the side effects must demonstrate a long lasting example of indication. This implies the turmoil is ordinarily recognized in late youth or early adulthood and holds on all through a life expectancy. Another necessity for the analysis of identity issue is that the pessimistic standards of conduct must pervasively affect all territories of a man's life; this incorporates work, hint connections, social working, and family. The conduct should routinely causes issues or brokenness, and can't be credited to some other kind of mental or physical disease (James Morrison, 2006). A person with an identity issue will indicate maladjustment in all parts of their life and the turmoil will be reflected in the instilled, inflexible, and useless examples that they exhibit all through their lifetime. As indicated by Frances, "identity issue for the most part deliver personality syntonic conduct, or predictable with the inner self honesty of the individual, and, subsequently, are typically viewed as suitable by the person. This may make the antagonistic standards of conduct be unbendable and extreme to change." (Frances, 1999) The treatment of identity issue is generally troublesome and regularly has constrained outcomes. In the DSM-IV there are three "gatherings" or groups that every one of the 10 identity issue fall into. Individuals with group A scatters are portrayed by odd or flighty conduct, unusual discernments or thoughts, bizarre discourse or activities, and trouble identifying with others (Frances, 1999). Individuals determined to have identity issue are all the more much of the time determined to have an Axis I issue too (James Morrison, 2006). Visit co-sullen analysis for group An identity issue are: agoraphobia, significant discouragement, over the top impulsive issue, and substance mishandle (Frances, 1999). Sort A clutters incorporate distrustful, schizoid, and schizotypal identity issue. Distrustful identity issue, the first of the bunch A disarranges, is described by extraordinary or superfluous distrustfulness, suspiciousness, and a general question of associations, gatherings, and others, is found in 0.5%-2.5% of the populace, all in all and happens all the more regularly in guys (Frances, 1999). A man with neurotic identity issue regularly considers, without reason or cause, that others are misusing, hurting, or misdirecting them, which represses them from growing cozy connections. As indicated by Dobbert, "The preposterous conviction that others are backstabbing and deceitful blocks their capacity to trust in others. The tormented individual trusts that the data that they give in certainty will be later used to bring them hurt" (Dobbert, 2007). Individuals with distrustful identity issue likewise tend to hold hard feelings and wind up irate for apparently kind impression of affront or wounds. These feelings of spite can be dependable and based out of apparent dangers or abuse. Regardless of whether the aim to hurt or malign the individual is absent, because of the steady desire that others are endeavoring to hurt them, a person with a suspicious identity issue makes a danger and will then hold noxiousness toward someone else for an overstated measure of time. This vindictiveness will summon outrage and threatening vibe that will in the long run prompt the estrangement and separation (Dobbert, 2007). The second of the group A clutters is the schizoid identity issue, it is portrayed by a general separation from social settings, a confined or quieted scope of feelings, and requirement for solidarity. It is found in 3% of the all inclusive community and influences ladies all the more generally then men (Frances, 1999). A man with schizoid identity issue neither wants nor appreciates close or private connections. As indicated by Dobbert, "People distressed with schizoid identity issue discover no enthusiasm for starting, creating, and keeping up cozy connections. It isn't phenomenal for these people to do not have the intrigue or want to be viewed as a piece of their organic family" (Dobbert, 2007). These individuals don't discover incorporation in gatherings or social settings especially fascinating or alluring and work to stay away from such settings. A man with schizoid identity issue is portrayed as "seeming thoughtful, yet not bashful", and appears incline toward their own particular organization as opposed to looking for associations with others. This regularly drives the individual demonstrating pretty much nothing if any enthusiasm for sexual or imply encounters, inclining toward demonstrations of self-satisfaction and sexual dream over individual contact. (Dobbert, 2007) Because of the lack of concern of private connections, the individual with schizoid identity issue creates restricted enthusiasm for exercises they appreciate and does not look to impart these exercises to others. They would like to concentrate on a couple of exercises and interests of a lone sort and to fixate on those interests with little respect to the view of others. They likewise appear to be unaffected by the acknowledgment, acclaim, or feedback of others including their activities and confinement. It winds up clear to people around them that a man with schizoid identity issue does not mind what others observations are and they frequently appear to be chilly, withdrawn, and dispassionate, "introducing an insipid or numb articulation to the world" (Dobbert, 2007). The last issue in bunch An is the schizotypal identity issue which is a condition described by contorted musings, practices, and working. "Enchanted reasoning", relationship challenges, extreme nervousness, and poor social abilities are additionally normal. (James Morrison, 2006) This issue influences 3% of the all inclusive community and is analyzed somewhat more in females then guys. (Frances, 1999) Individuals with schizotypal identity issue see things in an odd or strange way. Their translation frequently varies from that of others and is "particular to themselves" (which means no one else has comparable observations and considerations), however isn't based out of fanciful idea or contrasting social standards. A large number of these individuals trust that that they have extrasensory or otherworldly powers and credit their odd observations to this capacity (Dobbert, 2007). The confidence in hyper vision, mind control, the "intuition" and different types of "mysterious reasoning" regularly lead others to see these individuals as odd which strains social and work connections. To aggravate this, numerous individuals with schizotypal identity issue have a decreased capacity to comprehend other individuals' activities and react to them wrong and in a socially unsuitable way. Having couple of effective encounters with others regularly prompts social tension, suspiciousness, and neurotic ideation. Dobbert states "as opposed to inspecting one's self to decide the wellspring of others shirking, individuals with schizotypal identity issue trust that the others are scheming against them. Because of the powerlessness of self-introspections, the harrowed individual pulls back further and further secludes themselves, driving the individual to additionally fall into their preposterous reasoning" (Dobbert, 2007). Individuals with bunch B issue are portrayed by emotional, unusual, and dangerous practices and trouble with lack of caution, the infringement of social standards, and acting naturally harsh and threatening to others. Usually for these disarranges to impart co-horribleness to dietary issues, social fears, somatization issue, neurotic betting, substance manhandle, and post awful pressure issue (Frances, 1999). Incorporated into bunch B are reserved, fringe, theatrical, and narcissistic identity issue. As indicated by the DSM-V, the first of the bunch B issue is "the withdrawn identity issue, which is an inescapable example of nonchalance for, and infringement of, the privileges of others" (James Morrison, 2006). It is described by inability to comply with social standards, misdirection, impulsivity, hostility, unreliability, and absence of regret. It influences 3% of men and 1% of ladies, and is circulated equally all through all races (Frances, 1999). Individuals with reserved identity issue act against social standards and show little regard for legitimate practices. They are frequently captured or submit acts that could prompt showdowns with law implementation. As indicated by Dobbert, individuals with this issue "don't simply damage social norms...but, perform practices that are critical infringement of the criminal code" (Dobbert, 2007). This shows individuals with introverted identity issue are equipped for carrying out "the most appalling of violations" including assault, outfitted theft, and murder. This determination had been connected to huge numbers of the reported serial executioners, for example, Ted Bundy, Jeffery Dahmer, and John Wayne Gacy. (Dobbert, 2007)>GET ANSWER