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Health Administrators Role in Healthcare Tort Reform

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Abstract

The Obama healthcare plan is expected to occasion far-reaching effects on healthcare practice in the United States. Tort reform within the American healthcare context is perceived as the important missing link to a sound healthcare system that would replace the current order, which is deemed expensive due to the high incidence of litigation-based challenges. Health administrators have different approaches by which they could adjust the envisioned structure particularly with regard to reforms in the medical tort system. This study explores the different opinions and suggestions that have been projected towards the role of health administrators in healthcare Tort Reform. Generally, the suggestions extracted out of the different perspectives are centered on two factors. One is the retention and reinvention of the element of defensive medicine within the framework of reform. The second is the creation of structural systems that would necessitate a review of the tort system in a manner that would be consistent of the new healthcare operational climate.

Changing operational environment

            The operational environment of health care management in the United States is set to undergo significant changes following the advent of reforms occasioned by Obama’s health care plan. The system of medical administration before the Obama bill was perceived to be socially biased against the poor and the unemployed. From the perspective of medics, the structural design of the system was or is fraught with litigation challenges that slow down levels of efficiency in health care administration. Studies have indicated that the insurance dynamics under the old system were largely conditioned by the economic pressures on the market, (Studdert, Mello, & Brennan, 2004).

The flux nature of the American economic environment often meant that insurance policies would increase at unpredictable levels that in turn brought about significant financial challenges for companies, individuals, and medical administrators. There have been arguments that the new dispensation would go alongside tort reforms given the centrality of litigations as a factor that allegedly drives up the cost of medication. The bigger picture of this operational paradigm was that medical administrations were largely determined by forces beyond the needs of the patients and the professionalism of service providers (Rubin, & Joanna, 2007). The envisioned plan, which is supposed to roll out in the next ten years, aims at providing insurance cover for 32 million more Americans who were previously uninsured. Another factor that might determine the effect of this bill on medical administration is that 16 million more Americans will be placed under the government sponsored Medicaid insurance program (Clinton & Obama, 2006).

A wide range of scholarly concerns has been brought to bear on the exact dimension of the health care plan on the usual element of litigation in the American health systems. In the old order of medical administration, studies have offered that medical administrators tended to spend significant money and resources in fending off torts occasioned by technical mishaps that were clustered under the concept of professional malpractice (Donald, 2005). Two different opinions have been offered on the future scenario in the field with regard to the element of litigation. The first school of thought suggested by some studies argues that there is a possibility of increased volume of litigations logically drawing from the significantly increased level of clientele.

The second school of thought argued that the current levels of litigations would experience marked decrease because the health reforms will abolish the limits under which the medical administrators have strained to operate. This second opinion is largely derived from the fact that the current challenges facing the American health care system is a result of the structural deficits that impede the potential of medical administrators in their effort to provide quality and affordable health care. Litigation has become a central factor in the United States medical system in the sense that it is one of the major factors that doctors look for in the designing of their methodologies (Arlen & MacLeod, 2005).

The need for new litigation structures

            There have projections that part of the implementation of these health care reforms will bring into effect the need for the restructuring of the landscape of the legal frameworks that have supported the current levels of litigations within the sector, (Arlen & Macleod, 2005). Within the concept of this second consideration, it is expected that there shall be more money to undertake research in the medical field as focus significantly shift from litigation expenses to the provision of quality services. The old order has been that more money, which should have been expended on the pursuit of quality research, was mostly utilized in litigation matters (Jonathan, 2000).Besides, the government under the new plan has projected to undertake increased spending on research and incentives for the medics. This would, in the long run, guarantee quality healthcare to the American public and consequently lower the factor of litigation.

The provision of inappropriate medical care under the structures of defensive medicine has been encouraged by the increased dependency on structures outside the medical fraternity to provide medical care for the majority of Americans, (Dubay, Kaestne, & Waidmann, 2001). Redeeming the American health care system from the vicissitudes of the economy and litigations will herald a new climate under which medical firms will have the effect of stabilizing the environment in a manner conducive for the provision of professional services to a greater number of Americans. The bill, according to some studies was premised on the ideal of social justice for Americans regardless of their social and economic backgrounds. A broader assessment of these changes is to be observed from the heightened levels of medication that will necessarily follow the successful implementation of this plan. Precisely, there has been continuing debate regarding the possible methodologies that medical practitioners may adopt for the purposes of shielding themselves from all possible litigations.

The envisioned changes in the insurance fraternity are aimed at overhauling the pyramid of service that has traditionally concentrated its focus in limited segments that have been determined by the health status of the clients and their financial stability (Zuckerman, Bovbjerg, & Sloan, 1990). This overhaul of the insurance fraternity must ultimately touch off a series of structural adjustment policies in medical administration in order to adjust in the redesigned operational environments.

Targeted segments for reform

Some of the areas that are likely to be affected include costs of medication, quality of medication, preventive and curative medical services. According to some studies, medical practitioners will approach their services and duties with an aspect of confidence than in past cases in which the client’s insurance status was the sole determinant of the kind of treatment that patients would obtain from medics. The overarching goal of the Obama health plan is to put every American under the insurance umbrella. The second goal is to broaden the kind of policies offered by Insurance companies so that there is a wider choice from which the citizenry might choose from, depending on their respective health needs. This will make it possible for the medical administration to adopt policies that are precisely need-oriented rather than cost oriented like it has been practiced in the past (Currie, & MacLeod, 2008).

Consequently, a need-oriented approach to medical administration will yield more positive impacts on the nationwide health status than the prevailing system that locks out needy cases on reasons of costs. It might be argued, as a consequence, that the various kinds of administration approaches would have the overall effect of improving the quality of medical services in the American system.  Litigants will seek to ascertain the professional quality of the services they receive so that they seek redress at the most appropriate levels. The Obama plan has expanded the field of engagement between insurance companies and the medical field in a manner that will increase the possibilities of policies for subscription by the American citizens. On the positive side, some scholars have argued that there will be an increased element of honesty as compared to the old system of insurance. This argument is predicated on the fact that doctors in the United States have tended to work within the scope of the insurance policies.

 The services rendered to patients have, in most cases been tailored in a way that reflects the specifics of the policies subscribed to by the patient. This old trend has often meant that doctors have been hesitant to prescribe or administer tests and treatment that are not within the confines of the policy (Sloan, & Shadle, 2009). It is for these reasons that surveys have ascribed the increased rates of professional misconduct among medical practitioners. For instance, there have been reports of medics who prescribed cancer scans for the simple reasons that insurance firms would readily accept them conducted on their patients. The medical operational environment has, therefore, reflected strong symptoms of deterministic methodologies in which the field is defined by the insurance landscape. Researchers have illustrated that levels of efficiency in medical administrative are more positive in fields where the needs for medical care by the administrators determine the kind of insurance schemes and policies, rather than the other way round as it has often happened in the United States, (Studdert, Yang, & Mello, 2004).

Scholarly observations that have been projected towards the future scenario for medical practitioners point to the general assessment that the free market systems of medical administration will eventually be replaced by a public funded systems that carry significantly higher safeguards for the health of Americans that in the old order. Surveys in heath care administration have suggested that public funded systems and government regulated medical care systems are relatively more efficient and safer that those largely controlled by the free market dynamics. From this perspective, it has been observed that new health care administration is more human centered that the kind of health care administration that currently exists on the market. The Obama Health Care plan is largely aimed towards the objective of increasing the pool of Americans under insurance. Precisely the plan intends to put all American citizens under the insurance schemes.

 These health care reforms will provide sufficient safeguards for more Americans to receive higher quality services while enjoying the financial cushioning from a consolidated fund of upfront insurance. Some of the dimensions on which these reforms have been anchored have had to do with the previous challenges that have dominated the US health care administration systems. Studies have shown that the previous systems were increasingly marred by defensive medicine, higher mortality rates, and low incentives for the medical practitioners (Studdert, Yang, & Mello, 2004). The systems projected under the new design are largely anchored on the need for a increasing the level of administration of health care administration of Americans regardless of their financial status and the state of their health. There has been a strong element in the insurance regime of the United States where the providers largely sought to move into perceived safer regions.

The system was such that the beneficiaries of the health care systems were largely those in the higher brackets of income. Others more targeted were those whose status of health was generally stable and sound. The insurance firms had manifested a marked trend of minimizing the sale of their policies from the perceived high risk sectors of the population such that those who were not permanently employed and those who suffered from chronic of life threatening health complications. On the other hand, studies have found out that these two categories were the ones increasingly under the threat of poor health care services. This is because they were more prone to health challenges that those in the high income status or those with stable status of heath (Danzon, 1984).The heath care program was therefore designed in a manner that would capture these two largely ignored areas of the population. The implication of this is that a new operational environment has emerged in which the health care practitioners will have to adjust their trends and approaches in the administration of healthy care for these new categories of Americans.

 Taken together these changes are also expected to bring about far-reaching implications on the status of medical torts that would be experienced. The reason behind a possible change of scenario is the increasing possibility of that more Americans will have sufficient room to seek legal redress in cases where they will fell that their medical rights have been flouted (Arlen, & MacLeod, 2005). Logically, an expanded catchment area for the healthcare practitioners will also mean an expanded rate of legal challenges in the field of health care administration. The increased percentage of lawsuits is expected to bring about higher cost implications on the part of health car organizations in a manner that might determine their levels of sustainability, profitability, and proficiency. Studies have observed that the Obama bill is more focused on the welfare of the citizenry at the expense of the health care organizations. In fact most of the criticism that have been brought to bare on the health care plan have been centered on the fact that the new systems does not provide the necessary impetus for the health care practitioners to seek new ways or reaching out to the American people. The incentives provided for the medical practitioners, according to these analysts are piecemeal and not sufficient to guarantee increased investment into the sector. In essence, medical administrators will seek out new ways to cushion themselves from the possible adverse effects of the new health care regime.

 Most of the changes to be expected are likely to emanate from the dimension of costs. The sector will undergo significant changes in a way that would be informed by internal structural adjustment mechanisms for the sake of self-protection (Clinton, & Obama, 2006). In essence, the same studies have predicted that medical practitioners will adopt new operational mechanisms that will be aimed towards minimizing the possibilities of torts within their systems. The Obama plan has increased the incentives for the insurance firms to venture into an expanded arena of operation with the express intention of capturing the diverse sectors that were previously ignored in the old system of health care administration. In this respect, there will be increased policies to guard a higher number of Americans against medical malpractice. The structures that support the new design are made in such a way that they lower the threshold of medical malpractice.

Studies have shown that the level of torts to be instituted against the medical practitioners will witness a sharp rise owing from the various incentives, (Currie, & MacLeod, 2008). Health care administrators will have to adopt new ways in which they will seek to upset the existing challenges by way of minimizing the specter of litigations. The expected scenario is one in which there will be more focus on areas that are relatively less prone to litigation risks in the field of health care administration. In this regard, more American medical health administrators are likely to adopt specific strategies that would shield them from the possibilities of attracting lawsuits. Defensive medicine is one of the strategies that have been used occasionally by medical practitioner to shield themselves from the possibilities of torts,(Currie,& MacLeod, 2008). The trend has been an increased use of resources in a disproportionate manner to response to medical cases that would have been sufficiently handled through the utilization of lesser resources. In effect, such tendencies have been responsible for the perceived in-equilibrium in the balance of resources against the social factor in the provision of the medical administration in the United States.

 It is expected that there will be a likely surge in this areas given that the government will increase its budgetary allocations to shield the medical field in terms of resources. The scepter of defensive medicine is likely to shoot up in the emergent scenario because medical practitioners will endeavor by all convenient means possible to shield themselves from the possibilities of attracting lawsuits to themselves or their facilities. According to some studies, other responses that are likely to follow include increased levels of referrals for undeserving cases. Studies have indicated that medical private firms are likely to adopt more selective approaches through which they will avoid complicated cases that are deemed of higher risk. Health care administrators in the private field may tend to prefer to refer some cases to higher medical facilities particularly government sponsored ones in cases that they may perceive as potentially risky. This approach would reduce the element of risk since they will have transferred the possibility of the risk to health facilities of higher jurisdiction.

 From yet another perspective, some studies have argued that medical practitioners are likely to design their services in such a way that they promote more preventive medicine than curative medicine. This, according to these studies, is likely to be a coordinated approach in the sense that insurance policies will equally promote preventive policies as a way of preempting the costs of medical care that might result from the likely increase in the number of applicants. (Currie, & MacLeod, 2008).  Studies have shown that the administration of preventive medicine is significantly cost-effective than curative health care. Similarly, preventive care is less likely to attract malpractice litigations than curative medical care. Medical administrators would therefore align their policies in favor of preventive policies as a long-term measure of safeguarding the systems against torts. The problem of staffing has also been a significant factor within the element of litigation. This challenge can be perceived from the perspective that lack of sufficient qualified personnel throughout the United States has created a scenario where less qualified personnel have been charged with the provision of services (Dubay, Kaestne, & Waidmann, 2001).

The situation is likely to be worsened under the Obama plan because the available medical personnel may not easily accommodate the sudden upsurge of insured patients. The government plan to recruit more medical practitioners may not match the speed with which the new insured individuals will respond to their medical needs. The wider implication of this new structure would be the emergence of disequilibrium between the levels of individuals who require medical attention against the available number of trained medical personal to offer these services. The obvious short term and long-term interventionist measure would be to enlist the services of unqualified or less experienced medical practitioners to handle complicated cases that mat arise out of the scenario.

The margin of error in medical malpractice

Researchers have pointed out that this same level of disproportional has been to blame to the margins of error that have occurred within the old order. It is precisely these margins of error that result directly to increased levels of litigations. Critics have pointed out that the Obama plan may face implementation challenges because it lacks sufficient safeguards that would shield it against the challenges of implementation. The possibility of increased margin of error would cripple the systems, as the insurance firms for the medical administrators would not manage to handle the significantly higher costs to be involved in the litigations, (Studdert, Yang, & Mello, 2004). In this case, the medical practitioners are likely to maintain their old tendency of spending more resources in shielding themselves from the possibility of lawsuits. To accommodate the pressure of work, the medics may equally revert to the old system of prescribing expensive medical treatment with the purpose of raising the threshold for litigation in any complicated cases that they face. This would mean that the system reverts to defensive medicine that has been blamed for the poor levels of service delivery in the US health care system. One other approach for medical administrators would be shifting towards areas that are deemed less risky (Zuckerman, Bovbjerg, & Sloan, 1990).

This is because of factors of discrepancies of remuneration and lack of back up insurance to cover them against torts. In this regard, there would result an imbalance of staffing in some critical areas that are deemed more risky. However, some scholars have argued that it is immaterial to bring on board the aspect of tort reform because it does not constitute a significant percentage of the costs of medical care in the United States. According to some studies, the actual statistics of torts are significantly lower than perceived impressions on the same. These studies have argued that the component of medical liability has remained constant even as the costs of medical care continue to move upwards. Alternative explanations have been sought to bear on the cost factors of healthcare. Some of the reasons of the rise in the cost of medical care have to do with technological factors and processes of social mobility (Studdert, Mello, & Brennan, 2004).

The first argument has been that the increasing technological sophistication in the field of medical practice has occasioned increased costs in terms of medical care. The technological devices that are enlisted into the field have a high operational and maintenance factor. The second reason that the United States being a rich nation will necessarily have higher costs of medical care than less stable countries. Studies have offered that the health care system of the United States is around 2 trillion dollars (Currie, & MacLeod, 2008).On the other hand, the average tort claims per year are around 30 trillion dollars. This means that the percentage of the costs against the fiscal value of the system is around 1.5 percent. The impression created by this percentage is that the litigation factor in the US healthcare system is not significantly sufficient to determine the average costs of the system. Other studies have pointed out that the rate of litigations for professional misconduct has been on a downward trend from a variety of reasons (Arlen, & MacLeod, 2005). One reason is that there increased defensive medicine has protected medical administrators from the possible adverse effects of these litigations.

 In conclusion, it would seem that a variety of dimensions is available for medical administrators to engage with the new health care dispensation brought about by the Obama health care plan. Medical administrators may choose to adopt methods that would increase the quality of services provided to the increased volume of insured beneficiaries. This could be achieved through the utilization of the financial incentives for the purposes of training and specialization in the areas perceived as prone to litigations. Another way is that medical administrators would maintain the old approach of defensive medicine, which of course would be cushioned within the increased levels of spending.

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