Managed Care Provider’s Rights and Responsibilities

Types of health care providers

• Health care providers in a hospital
• Providers in residential long-term care facilities
• Providers of ambulatory health care
• Providers of different ancillary services
• Retailers and other providers of medical goods
• Providers of preventive care services

Note: Hospitals are primarily involved in health care services to inpatients and outpatients. Residential long-term care facilities combine health and social services. Ambulatory care concentrates on outpatients. Ancillary services are provided to outpatients under health professionals’ supervision (World Health Organization, 2011). Retail sale of medical goods refers to retailers and other providers’ activity. Within preventive care, organizations launch campaigns for population or its groups.

Care providers’ personal qualities

• Advanced communication skills and empathic ability
• Emotional stability and high stress resistance
• Flexibility in terms of working hours
• Great physical stamina and sufficient strength
• Attention to details and problem-solving skills
• Strong work ethics and dedication to work

Note: Health care is demanding. A person should be a good communicator and endorse empathy for patients without letting feelings prevail over sense. It is necessary to be physically vigorous. One may have to lift heavy objects and endure long working hours. Intelligence, scrupulousness, and tactfulness are also significant to deal with patients.

Health care providers’ rights

• Providers’ rights as fundamental human rights
• Right of conscience and care denial
• Care denial based on providers’ health
• Right to file complaints and have them resolved
• Right to open interaction with patients
• Right to receive written documents and decisions

Note: Just as all people, health care providers have fundamental human rights. They have the right to deny care for various reasons. It is possible to interact with authorities. For example, they can make a complaint (The Official Website, n.d.). Providers may discuss diagnoses and treatment policies with patients.

Health care providers’ responsibilities

• Evaluate patients’ condition, injuries, and diseases
• Provide suitable treatment via different venues
• Provide patients with short-term care services
• Provide patients with long-term care services
• Act as educators to prevent diseases
• Administrate facilities and protect patients’ privacy

Note: Health care providers’ responsibilities are numerous. They must thoroughly consider patients’ health and use different ways to provide adequate treatment. Short- and long-term services are included. Another responsibility touches on educating people: it is vital to explain what they should do to recover and prevent diseases. Health care providers must perform administrative duties and make use of facilities.

Health care providers’ payment

• Fee-for-service as a predominant mechanism for GPs
• Capitation for physicians and nurse practitioners
• Salary and doctors in public hospitals
• Global budget for all hospital’s expenditures
• Payment per case as a simple form
• Payment per procedure as a simple form

Note: Nowadays, many payment mechanisms are used. Fee-for-service implies separate payments for each service. Capitation is also common: a fixed amount for each person covered is paid (World Health Organization Regional Office, n.d.). Physicians in public hospitals have salaries. In global budget model, hospitals obtain a sum of money at a period and cover all expenses.

Factors providing positive communication among health care providers

• Collecting relevant information about a case
• Accurate problem statement and complaints description
• Active listening to health care provider’s information
• Specification of unclear issues by questions
• Assertive communication and delicate case approach
• Teamwork skills and respect for others

Note: To improve services quality, health care providers need to communicate. Whether cooperation is a success depends on several factors. It is important to gather information, for instance, vital signs, and represent it properly. Careful listening and feedback in the form of questions are significant. One should be tactful, polite, and attentive.

Self-assessment

• Patient-centered approach and patient gain in health
• Achievement of organizational and managemental goals
• Conducting research, continuous training, and self-education
• Expertise and implementation of new technologies
• Quality of services enhancement and safety
• Human resources involvement and facilities usage

Note: Evaluating one’s professional activity is an integral part of work. Health care providers may rely on the criteria relevant for all medical realms. One should consider whether one’s actions focus on patients. Quality of services and organization are urgent (European Reference Networks, 2016). Moreover, technologies usage and research constitute measures of evaluation.

Ethical challenges

• Discord with patients/relatives about forms of treatment
• Distribution of limited resources among patients
• Medical errors and wrong diagnoses
• Treatment of dying and seriously ill patients
• Patients’ long wait for specialist consultation
• Patients’ participation in research and experiments

Note: Health care providers have to face plenty of ethical challenges: each case is individual and requires personal approach. Among the most common issues are disagreement with patients and their families about treatment, medical errors, and resource assignment (Pinto & Upshur, 2013). Treatment of terminal patients is also challenging. The fact that some patients have to wait for consultation refers to deontology. Researchers also demand ethical issues consideration.

Stress among health care providers

• Dental care as the least stressful sphere
• Physiotherapists’ and orderlies’ relatively low stress
• Medical laboratory technicians’ high stress indicators
• Specialist physicians’ increasing stress rates
• High stress levels among registered nurses
• Head nurses’ and nurse supervisors’ stress

Note: Stress among health care providers is inevitable. However, health care providers from different areas are influenced in dissimilar ways. Dental care field is considered the least stressful (Health care workers, 2014). Similar to them, physiotherapists’ and orderlies’ stress rates are low. Physicians, RNs, head nurses, and nurse supervisors are recognized as the most stressful occupations.

Reasons for dissatisfaction and burnout among health care providers

• A very large number of patients
• A continuous weight of patient responsibility
• Mountains of paperwork and administrative functions
• Lack of opportunities for career advancement
• Negative political changes concerning health care system
• Imbalance between work and personal time

Note: Many health care providers are dissatisfied and suffer from burnout. Indeed, there are factors that contribute to it. A large number of patients and higher responsibility may oppress a health care employee. While there are few career development chances, paperwork and organizational issues consume hours. Consequently, a person does not have enough time for themselves and feels dissatisfied.

New technologies and innovations assisting health care specialists

• Social media and real-time patient contact
• MHealth and easy health checking technologies
• Sparing and more effective patient treatment
• Electronic health record and instant access
• Self-service kiosks as an organizational instrument
• Secure sharing information with patients and families

Note: To overcome difficulties and solve problems, new technologies are essential. They bring advantage to administration. It is possible to manage records and share information with patients privately. Moreover, owing to innovations, health care providers can establish direct contacts with patients and examine them remotely, for example, via mHealth. Treatment becomes more sparing. Individual specialists’ competencies and skills validation.

The importance of lifelong learning for health care providers

• Professionals’ involvement in acquiring new knowledge
• Knowledge solidification and career interest generating
• More career opportunities in related fields
• Gaps between theory and practice reduction
• Patient care outcomes and health improvement
• Professional satisfaction and motivation increase

Note: To meet the challenges of the changing world, health care providers should adhere to the principle of lifelong learning. It will help them gain new knowledge, find career opportunities, and master theoretical and practical skills. Patient care outcomes are expected to improve. Consequently, professional satisfaction and motivation will grow. Thus, lifelong learning will be effective.

References

European Reference Networks. (2016). Self-assessment checklist for health care providers. Web.

Health care workers may be the nation’s most stressed employees. (2014). Web.

Pinto, A. D., & Upshur, R. (2013). An introduction to global health ethics. New York, NY: Routledge.

The Official Website for the State of New Jersey. (n.d.). Managed care provider rights and responsibilities. Web.

World Health Organization Regional Office for Europe. (n.d.). How are hospitals funded and which payment method is best? Web.

World Health Organization. (2011). A system of health accounts. Paris, France: OECD Publishing.