The array of regulations governing the healthcare system can be overwhelming especially among people working in the industry. Healthcare professionals may have a feeling that they spend most of their time complying with various rules directing their work instead of performing their duties (Field, 2008). The complexity in the system results from wars between opposing interests that have existed for more than 150 years. Currently, disputes focus on the type of power enshrined between the government, insurance companies and professionals in the healthcare system.
The authority of medical professionals over governments and insurance companies results from the ability of setting and controlling prices in the industry. Approximately 80% of Americans have health insurance policies but have no idea of the costs of services (Penne, 2012). The professionals are involved in rate negotiation with insurance companies, other institutions responsible for covering the healthcare costs or with governments. This puts the healthcare institutions in the best position of making money, setting the rates charged and quietly overcharging the patients.
Given the power of the medical professionals in setting the rates in the market, and overcharging the patients, they should have minimum authority and power over insurance companies and government agencies (Timmermans & Oh, 2010). The governments and insurance companies should collaborate to ensure that the economic benefits are transferred to the public instead of private healthcare institutions and medical professionals. This is because the increasing commercialization of healthcare after the Second World War has resulted to institutionalized altruistic collective orientation. Therefore, the doctors should only be limited to evidence and clinical decision-making (Field, 2008).
Having authority over clinical decision-making can be effective in minimizing the exclusive power of doctors to overcharge their services since they submit their decisions to experts before insurance companies compensate them (Timmermans & Oh, 2010). This offers doctors with the best evidence having aimed at specific clinical questions. Through the EBM, the governments can ensure that the doctors and other medical professionals attend the best medical schools financed as well as governed by Medicare programs to regulate the payment of medical services. However, insurers have found a problem with EBM because of practice variation among the medical practitioners resulting to mistreatment, under treatment and over treatment.
Field, R. (2008). Why Is Health Care Regulation So Complex?. Pharmacy And Therapeutics, 33(10), 607. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730786/
Penne, W. (2012). The authority the medical profession has over insurance. Wil Penne. Retrieved 21 June 2016, from https://thedigitalcarp.wordpress.com/2012/09/20/the-authority-the-medical-profession-over-insurance/
Timmermans, S. & Oh, H. (2010). The Continued Social Transformation of the Medical Profession.Journal Of Health And Social Behavior, 51(1 Suppl), S94-S106. http://dx.doi.org/10.1177/0022146510383500
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