The increase the average life expectancy of American citizen rests on our adoption of new technologies in medical care. This has precipitated the rise in the general cost of heath care. Acknowledging the fact that the health indicators of a people directly reflect on health of a nation and that the adoption of health care law is fundamental to the stability of a nation are true statements. This important and sensitive role remains in the hands of the state. These laws can therefore be defined as state based. This paper will review the relevant health care laws that impacts heath care professionals most directly. Towards this, an analysis of how the law and its ethical decisions work together will be synthesized.
Heath maintenance organization act 1973
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A health organization according to this act refers to a public or private entity that is organized under state law. Cornell University Law School (1), illustrates the roles of Heath maintenance organization as public or private entity charge with the responsibility to;
1). provides basic and supplemental health services to its members in the manner prescribed by subsection (b) of this section, and
(2) is organized and operated in the manner prescribed by subsection (c) of this section, among other roles.
The inability to undertake the above roles as prescribed within this act will definitely run contrary to its provisions and thus lead to an offence. Secondly, the inability to meet the code standards set by this act as prescribed in its provisions automatically denies one the opportunity to offer high deductable health plan as stated in section 220
Health care professionals within a health care organization must adequately apply the right provisions of this act to avoid the risk of insolvency. The American health care culture is dominated by medical organizations that provide medical care as opposed the individual approach in Europe. This is because their operations are heavily influenced the provisions of Medicaid and Medicare acts. The financial records of these health care organizations are better kept safe from the Internal Revenue Authority to avoid the instances of poor tax returns that govern the operations of heath care organizations.
The second health care law that impacts health care professionals more directly is the Medicaid law. A programme that is directed to support the law income members of the society and is embedded in 42 U.S.C. §1396 et seq and was enacted in 1965. This law affects the health care professionals more directly and has been on focus because it has been abused by both the healthcare professionals and the patients. Heath care professional must adequately understand the provisions of this law because the federal government does not re- emburse the total amount in medical related expenses incurred by a patient. This knowledge will definitely assist a physician to limit the number of patients he can attend to in order to remain in business. Furthermore, this knowledge is critical in avoiding unnecessary problems related to the federal returns that have seen heath care professionals charged with misconduct in relation to poor submission of incorrect medical returns for refunds.
A deeper understanding of this act will enable the heath care professional to increase their levels of provider reimbursement. According to Goodman (2009), "Perhaps the most scrutinized area of this legislation is provider reimbursement because Medicare had been scheduled to cut provider reimbursement by more than 10% starting January 1, 2008 and this cut was placed on hold for six months until July 1, 2008". Furthermore, "Providers delivering psychotherapy and related services will see restoration of a portion of cuts recently applied in these areas as addressed in Section 138 - Adjustment for Medicare mental health services". This illustrates that this provision not only directly impacts on health care professionals but also affect the way they undertake their businesses.
The third category of laws that directly impacts on health care are legislations that restrict networks and utilization review, place limitations on benefits and impose general restrictions on managed care (Goodman, 2009 ). The network restrictions seek to limit the number of health professional of a given specialty. The next law related to the above legislations "Any willing provider" laws. According to Cooper (1991), "The most common provision affecting network operation is the "any willing provider" statute, which requires managed care plans to accept or offer the opportunity of participation to any provider meeting their selection criteria in that such mandates are intended to ensure that all licensed health care practitioners in a state are permitted equal access to the beneficiaries of managed care plans"
These legislations directly impact on health care professional in that they affect their operations. Any willing provider aligns the prescription in regard the drug plans. This is because these laws mandate health care professionals to order drugs by the exclusive use of mail.
Health care professionals also come under the legislations by the mandating of class providers. This affects health care professionals because they require the coverage of specific providers as entrenched in the medical insurance legislations. Specific providers that impacted by legislation include psychotherapists, optometrists, podiatrists, and chiropractors. While these laws had profound positive contribution to the patient and the health care professional, there are still differences on their exact relevance to the medical care industry. This issue is supported by Cooper (1991) in stating that "Proponents of these laws argue that beneficiaries should have the freedom to choose the type of provider from which they receive services while supporters of managed care, however, respond that having multiple classes of providers deliver the same service makes the operation of an organized, managed system more difficult".
This class argue that giving absolute power to the providers to specific providers reduces the ability of managed care plans to avail the best providers so that the demands of their members can be effectively met.
In addition to the above, there are a number of laws that impact directly to the health care professionals. Such laws impede on network operations and such affects the operations of heath care professionals. A good example of such legislations is a 1990 statute that demands that every HMO licensed to carry out a business must provide the services statewide. This law prohibits the operations of such units in defined areas. According to Cooper (1991), "Such a requirement compromises the most highly organized forms of managed care, such as group practice HMOs and it is unlikely that there are sufficient participating providers or population to support this type of managed care program in every area of a state"
In conclusion, there are a large umber of laws, statutes, and legislations that directly impact on health care professional. The ability to effectively balance work as a heath care professional and stay in line with these laws demands the role of deep knowledge in translating these laws and applying in them in the code of practice. This is the only sure way to avoid conflicts between t health professional and the law enforcers.