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Parsonian analysis of TennCare, a managed-care health system in the state of Tennessee.... More...
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Parsonian analysis of TennCare, a managed-care health system in the state of Tennessee. Problems of the TennCare health care system. Presents reasons why the system is dysfunctional, including underfunding.
In the field of medical sociology the theoretical perspective ofTalcott Parsons is useful in analyzing the social arrangements of a healthcare system Parsons and Edward Shils analyze social systems in terms ofhow they function They cite the general tendency toward conformity with anormative pattern p and a tendency of systems of action to buildup and maintain levels of consistency Parsons Shils p Butthey also say that the fundamental need for order in a system is the rootof the strain which appears when
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It is at this point that TennCare's underfunding problems enter thepicture. (199 ). Retrieved from the World Wide Web 3 March 2 3 at http://www.heartland.org/archives/health/dec 1/bias.htm.Gilstrap, M.R. Adverse selection presumes that those who make deliberatechoices have more (asymmetrical) information than others to maximize theirstatus. Thus shortfalls between program funds (from taxes andpremiums) and health-care-delivery costs actually incurred would be made upby tax money; TennCare is a public program. Thus not all systems are in order. As well, the "medicallyuninsurable," or those with profound health problems, plus uninsuredindividuals ineligible for employer plans or Medicaid, as well as allchildren and all "dislocated workers" came to TennCare. AllMedicaid recipients were transferred to TennCare. Culture and Society: Contemporary Debates. The analysis of deRugy and Miller, which is general and not specificto Tennessee, is that the presumption that adverse selection dominates thehealth-care system has fostered needless and destructive intervention inpublicly funded programs. The equity of such a result must bequestioned. Health care was delivered via managed careorganizations (MCOs), which received set monthly "capitation" fees based onage, sex, and disability. Alexander & S. Chicago, Ill.: Heartland Institute. In the field of medical sociology, the theoretical perspective ofTalcott Parsons is useful in analyzing the social arrangements of a healthcare system. When the program was first enacted the claim was that it wouldsave money while providing a safety net to the medically uninsured. Parsons and Edward Shils analyze social systems in terms ofhow they function. The intent was to save enough money through efficiencies wrought through managed care and by converting federal and state payments made directly to hospitals for indigent care to payments for insurance coverage. Some MCOs were forced out of businessanyway (Conover, 2 ). 39-46. Truths for TennCare. They cite "all sorts of regulatory interventionsand compulsory health insurance schemes that favored equity over efficiencyand risk-spreading over personal health maintenance incentives" (2 1). An asymmetric bias toward government regulation. Indeed, theTennCare health-care system is disordered. 44). What actually happened was that money was not saved, that insurers didnot receive enough funding to reimburse health-care providers on a timelybasis. Seidman (Eds.). Whether an adverse selection or an improperlyconceived administrative system was at work, the main effect was economic:disempowering market forces from functioning efficiently for theindividuals who make up the health-care marketplace. Values and social systems. Tax increases would beinevitable, burdensome, infinite. 4), the namegiven to the process whereby patients who have lower heath risksdeliberately purchase less insurance coverage than they need so as to avoidsubsidizing high-need insureds who tap into the benefit pool that insurancepremiums fund. (2 , October). Uninsured anduninsurable "pay a sliding-scale premium based on income" (Conover &Davies, 2 , p. The theory of adverse selection (deRugy & Miller, 2 1) is that themore it occurs, the more likely insurance premiums increase, since the poolof reimbursement money to pay for services actually provided will bleeddry. Nashville, Tenn.: Tennessee Institute for Public Policy.Parsons, T., & Shils, E. In Tennessee, one equity intervention was to make persons alreadyinsured eligible for TennCare at unrealistically low premiums and anotherto capitate MCO payments below market norms (Gilstrap, 2 ), thusdisrupting Parsons' conception of normative patterns. An important feature of the Urban Institute's report is its citingof reports of adverse selection (Conover & Davies, 2 , p. 45). 3). Works CitedConover, C.J., & Davies, H.H. (2 1 December). These funds, together with some new state tax revenues, were expected to finance the expansion of coverage (Conover & Davies, 2 , p. Cambridge: Cambridge University Press. 41), and "a tendency of systems of action to buildup and maintain levels of consistency" (Parsons & Shils, 199 , p. MCOs reimbursed providers on a case-by-casebasis. 2-3). 2-3). Add to this Gilstrap's contentionthat TennCare improperly enrolled ineligible patients; disenrollment wasnot systematic. Originally pushed through a majority-Democratic Tennessee legislatureby a Democratic governor in the mid-199 s, TennCare has squandered fundsand goodwill through mismanagement and enabled inefficiencies to dominatehealth-care delivery. Intense political advocacy also meant that indigents would not payeven $1 for publicly funded health care of which they were the mainbeneficiaries (Gilstrap, 2 , p. But MCOs denied some coverage, though high-risk employees droppedtheir employers' insurance coverage in favor of TennCare's more affordablepremiums and wider coverage. That describes a dysfunctional system. J.C. Butthey also say that the "fundamental need for order in a system is the rootof the strain which appears when an inconsistent value system is translatedinto action" (199 , p. According to the nonpartisan Urban Institute, the original objectivesof TennCare were "to expand [health-care] coverage to all low-income peoplein [Tennessee] and to rely on private managed care plans as the mechanismfor delivering care to new eligibles and those traditionally covered byMedicaid" (Conover & Davies, 2 , pp. Washington, D.C.: Urban Institute. 6). Retrieved from the World Wide Web 3 March 2 3 at http://newfederalism.urban.org/html/occa33.html.DeRugy, V., & Miller, T. Role of TennCare in health policy for low-income people in Tennessee. They cite the general "tendency toward conformity with anormative pattern" (p. No wonder MCOs wouldtry to save money by denying claims. (2 , February). Assessing the New Federalism. Health Care News.
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