Question

1) Do you think the results of the RAND study are likely to over-or-underestimate the likely effects of the ACA on the use of health services? Explain your answer.

2) Is pre-admission certification along with concurrent review a successful strategy in reducing hospital days?, explain your answer.

Do you believe this strategy contributes to the hospital readmission rates?

3)Explain how selective contracting works in the hospital industry; does selective contracting create competition for services? explain your answer.

Answer 1

1. I think the results of the RAND study are likely to underestimate the likely effects of the ACA on the use of health services.

RAND study is an experimental study of the cost of the health care services provided to the people, it's utilisation and outcomes in the U.S. They had assigned people randomly for various different kinds of plan and had observed their behaviour for certain time. It provides the research and analysis to the army force of U.S. It is financed by the Government and the private institute.

ACA is the affordable care act which provides the minimum coverage of the essential health care to the people. But the people should have certain criterion in order to receive those services.

As RAND study provides different plans to the public as well as they pick the people randomly for the study and provide as much as health benefits required by the people they are less likely to be exposed to the ACA facilities or any other facilities. Also because they are completely satisfied with RAND benefits that they don't want to waste their time in exploring other types of health benefits. The other reason would be because the RAND is an experimental study hence does not require any criteria's and anyone interested may have the possibility to be selected but in ACA the people have to fulfill certain criteria such as having health insurance etc.

2. Yes, the pre admissoad certification along with the concurrent review is a very successful strategy in reducing the hospital days. It is so because the pre admission certificate allows only the admission of those who are in need of the hospitalisation and others who does not needs are provided with required medical treatment and discharged. Here they are more likely to prevent the unnecessary and unwanted hospital stay of the patient. In this, the patient as well as the concerned physician sits together and reviews all the health related aspects including patient's diagnosis, planned treatment, the length of the stay at the hospital as well as the procedure planned for the patient and the setting in which the services are given to the patient which will ultimately determine the required need of the hospitalisation and the minimum hospital stay for the treatment.

Yes, I do believe that this strategy definitely contributes to the hospital readmission rates because the admission is done only for the patient's who requires it and also promotes the minimum amount of the stay. Hence, the patient's will definitely have to readmit themselves when they get any kind of relapse or reoccurrence of the disease condition. Also the treatment provided cannot be fully observed by the physician which may lead to any kind of complications later unknown to the physician and may have to be readmitted for the same.

3. Selective contracting refers to the minimisation of the freedom of choosing the health providers for the patient over the selection done by the insurer. The patient will have restriction on which care provider to select for taking care for themselves. The selective contracting companies work by tying up with certain hospitals or agencies and try to get the services for their customers from only that particular hospital. Yes the selective contracting creates a sense of competition for services because the customers Will only be choosing the hospitals provided by their servers and not by themselves which will make the minimum customers to the other hospitals where the tie ups are not present.