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Health Care Fraud and Industry Structure in the United States
Author(s) -
Skeen James W.
Publication year - 2003
Publication title -
social policy and administration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.972
H-Index - 63
eISSN - 1467-9515
pISSN - 0144-5596
DOI - 10.1111/1467-9515.00355
Subject(s) - health care , balance (ability) , business , managed care , activity based costing , power of attorney , economic justice , criminal justice , power (physics) , politics , public relations , law and economics , economics , political science , law , medicine , marketing , physics , quantum mechanics , physical medicine and rehabilitation
The cost of health care fraud and abuse is enormous. Not only is it costing us a lot of money but one wonders how many more people could afford and receive medical insurance if fraud and abuse were significantly lower. This paper will show that the problem is embedded in the way America does health business. The problem needs to be better addressed by both the criminal justice community and the health care industry. Most importantly, those making the health care industry policy decisions need to make a paradigm shift. The system is out of balance because of past policies and decisions that have given excessive power and liberty to the medical services community and insurance providers. Using O’Toole's Compass Card of the four major ideas that have influenced political decision‐making as a guide, this paper recommends that current decision‐making needs to strengthen the equality and community poles and restrict the liberty and efficiency poles so that more balance might exist within the American health care system. Talcott Parsons saw the dangers of commercializing health care over half a century ago. The health care scene of today shows that he was correct in his appraisal.