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Quality Information And Quality Competition In The Managed Care Health Insurance Market
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Book Synopsis Quality Information and Quality Competition in the Managed Care Health Insurance Market by : Nancy Dean Beaulieu
Download or read book Quality Information and Quality Competition in the Managed Care Health Insurance Market written by Nancy Dean Beaulieu and published by . This book was released on 1998 with total page 320 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Insuring Premium Risk in Competitive Health Insurance Markets by : Mathias Kifmann
Download or read book Insuring Premium Risk in Competitive Health Insurance Markets written by Mathias Kifmann and published by Mohr Siebeck. This book was released on 2002 with total page 178 pages. Available in PDF, EPUB and Kindle. Book excerpt: English summary: Auf privatwirtschaftlich organisierten Krankenversicherungsmarkten wird die Pramie entsprechend des individuellen Risikos erhoben. Verschlechtert sich der Gesundheitszustand einer Person, so besteht die Gefahr, dass die Pramie angehoben wird. Die Person sieht sich einer unsicheren Pramie gegenuber. Mathias Kifmann untersucht, wie dieses Pramienrisiko auf wettbewerblich organisierten Krankenversicherungsmarkten versichert werden kann. Drei grundsatzliche Moglichkeiten der Absicherung werden analysiert und verglichen. In einer vertiefenden theoretischen Analyse untersucht der Autor Reformmoglichkeiten der privaten und der gesetzlichen Krankenversicherung. German description: How can it be avoided that consumers face premium risk, i.e. increases in their premiums when their health status deteriorates? Mathias Kifmann examines how this problem which is a major challenge for private health insurance markets can be solved. Three principal ways to insure premium risk which preserve competition among health insurers are analyzed and compared. Guaranteed renewable contracts ensure premiums independent of changes in the health status by requiring a life-time commitment to an insurer. Premium insurance compensates an increase in premiums if the health status changes. Under community rating, the government rules out risk-based premiums by requiring that insurers set a uniform premium for all insured.Mathias Kifmann pays particular attention to the challenges posed by managed care. He argues that managed care can aggravate the lock-in problem under guaranteed renewable contracts. He demonstrates that an alternative contract is superior to guaranteed renewable contracts. This contract creates incentives for insurers to behave in the interest of consumers by specifying payments upon switching to another insurer. If insurers are community-rated, an important question is whether they should be allowed to offer managed care besides traditional health insurance. The author shows that managed care can be used as a pure risk-selection device under community rating. However, the introduction of managed care can also be to the benefit of everyone. To obtain such welfare gains, it may be necessary to tax some insurance plans and to subsidize others.
Book Synopsis Collaboration Among Competing Managed Care Organizations for Quality Improvement by : Institute of Medicine
Download or read book Collaboration Among Competing Managed Care Organizations for Quality Improvement written by Institute of Medicine and published by National Academies Press. This book was released on 1999-02-09 with total page 61 pages. Available in PDF, EPUB and Kindle. Book excerpt: In November, 1997, The Institute of Medicine convened a one-day conference to explore areas for potential collaboration to improve quality among competing health plans consistent with antitrust and other legal requirements. The conference was convened to clarify the limits of such potential activities and to explore ways to stimulate collaboration; in short, to explore permissible and promising areas for collaboration for competing health plans. Competition has existed at the provider level in the pre-managed care era and continues among physicians, physician groups and hospitals today. What is new is the extent of competition at the managed care organization level in individual regional markets. As large numbers of individuals are enrolled in health plans, the potential for new forms of cooperation for improving quality of care becomes possible. Along with these new possibilities, however, come questions about whether they bring the potential for antitrust violation.
Book Synopsis Competition and Quality in Health Care Markets by : Martin Gaynor
Download or read book Competition and Quality in Health Care Markets written by Martin Gaynor and published by Now Publishers Inc. This book was released on 2006 with total page 83 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides an economic assessment of the impact of competition on quality in health care markets. This book offers performance standards for competition; findings from economic theory; and, empirical evidence on health care competition and quality.
Book Synopsis Models of Health Plan Payment and Quality Reporting by : Jacob Glazer
Download or read book Models of Health Plan Payment and Quality Reporting written by Jacob Glazer and published by World Scientific Publishing Company. This book was released on 2016-12-22 with total page 208 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book pulls together a series of articles by the authors that initiated the research areas of "optimal risk adjustment" and "optimal quality reporting." The papers present the basic theoretical models and link them to empirical application. Design of health insurance premiums to achieve efficient and fair outcomes is also covered. The chapters in the book also cover the intellectual development of approaches to health insurance regulation, beginning with more abstract models to those with explicit empirical and policy applications.
Book Synopsis Competitive Managed Care by : John D. Wilkerson
Download or read book Competitive Managed Care written by John D. Wilkerson and published by Jossey-Bass. This book was released on 1997 with total page 438 pages. Available in PDF, EPUB and Kindle. Book excerpt: This edited collection--written by the movers and shakers in the industry--provides a "big picture" look at the rapidly changing health care environment. The book explores the important issues affecting the move to a managed care such as measuring and monitoring quality, mergers, the physician-patient relations, , and reconfiguring the work force.
Book Synopsis Care Without Coverage by : Institute of Medicine
Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Book Synopsis The Challenge of Regulating Managed Care by : John Eugene Billi
Download or read book The Challenge of Regulating Managed Care written by John Eugene Billi and published by University of Michigan Press. This book was released on 2010-02-01 with total page 307 pages. Available in PDF, EPUB and Kindle. Book excerpt: Representatives of industry, government, caregivers, and consumers join scholars and policy analysts in comparing market forces to regulation as potential means for righting what is wrong with managed care. The contributors that John E. Billi and Gail B. Agrawal have gathered here quickly move the healthcare debate beyond the classroom, think tank, and statehouse to the boardroom and examining room. Some argue strongly that the solution is to be found in the democratic process and government intervention, while others maintain that only market forces in a competitive environment can respond quickly to the needs of consumers and purchasers alike. The contributors' diverse opinions about the oversight of managed care reflect an enduring divide, one that will affect how society ultimately resolves questions about the inevitable tradeoffs among health-care quality, cost, and access in an environment of limited resources. The Challenge of Regulating Managed Care will appeal to policymakers, those in the medical field, and all readers interested in the American experience with managed care. John E. Billi is Associate Professor of Internal Medicine and Medical Education; Associate Dean for Clinical Affairs, University of Michigan Medical School; and Associate Vice President for Medical Affairs, University of Michigan. Gail B. Agrawal is Associate Professor of Law, University of North Carolina, Chapel Hill.
Book Synopsis The Changing Health Care Marketplace by : Walter A. Zelman
Download or read book The Changing Health Care Marketplace written by Walter A. Zelman and published by Jossey-Bass. This book was released on 1996-05-31 with total page 372 pages. Available in PDF, EPUB and Kindle. Book excerpt: Explores the Rise of Managed Care An incisive and informative analysis of our rapidly changing health care system--the best of current books on the subject. --Arnold S. Relman, former editor-in-chief, New England Journal of Medicine Walter A. Zelman, a leading expert on health care research and policy, examines the key trAnds that are changing today's health care marketplace. He looks at the growth of managed care; the new and sometimes uneasy partnerships among physicians, hospitals, and health plans; and the trAnd toward integration between sectors. This important resource draws on the latest data and research, including more than fifty interviews with expert analysts and practitioners.
Book Synopsis Managing Managed Care by : Institute of Medicine
Download or read book Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Author :Joseph L. Verheijde Publisher :Springer Science & Business Media ISBN 13 :9781402041846 Total Pages :246 pages Book Rating :4.0/5 (418 download)
Book Synopsis Managing Care: A Shared Responsibility by : Joseph L. Verheijde
Download or read book Managing Care: A Shared Responsibility written by Joseph L. Verheijde and published by Springer Science & Business Media. This book was released on 2005-12-09 with total page 246 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book traces the growth of managed care as a mechanism for curbing excessive growth in health costs, and the controversies that have risen around for-profit health care. Also examined are decentralization in US health care, and the absence of comprehensive health care planning, access rules, and minimum health care benefit standards. Finally, the author proposes a framework for improving access to quality, affordable health care in a competitive market environment.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :030946921X Total Pages :161 pages Book Rating :4.3/5 (94 download)
Book Synopsis Health-Care Utilization as a Proxy in Disability Determination by : National Academies of Sciences, Engineering, and Medicine
Download or read book Health-Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Book Synopsis Healthy Markets? by : Mark A. Peterson
Download or read book Healthy Markets? written by Mark A. Peterson and published by Duke University Press. This book was released on 1998 with total page 452 pages. Available in PDF, EPUB and Kindle. Book excerpt: Discusses the various implications of the new managed-care health care systems.
Book Synopsis Regulating Managed Care by : Stuart H. Altman
Download or read book Regulating Managed Care written by Stuart H. Altman and published by Jossey-Bass. This book was released on 1999-06-25 with total page 408 pages. Available in PDF, EPUB and Kindle. Book excerpt: What should be government's role in a market-oriented health caresystem? What's the appropriate amount of regulation? Who should regulate-states, federal government, or marketforces? What role do the courts play in this regulation? Are there existing models that might guide leaders in designing aneffective regulatory structure? Welcome to the great managed care debate. In Regulating ManagedCare, twenty-six of the nation's leading health policy experts givehealth care administrators, clinicians, and policy makers insightinto the issues behind this critical exchange and provide leaderswith a road map to assess the policy options available to protectthe quality of our health care delivery system. "This collection of papers, from an extraordinary group of authors,makes a valuable contribution to the ongoing policy debate and willbe of interest to anyone concerned with the future of our healthcare system."---Charles A. Sanders, retired chairman and CEO GlaxoInc. and former general director, Massachusetts General Hospital
Book Synopsis What Do We Know about Competition and Quality in Health Care Markets? by : Martin Gaynor
Download or read book What Do We Know about Competition and Quality in Health Care Markets? written by Martin Gaynor and published by . This book was released on 2006 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: "The goal of this paper is to identify key issues concerning the nature of competition in health care markets and its impacts on quality and social welfare and to identify pertinent findings from the theoretical and empirical literature on this topic. The theoretical literature in economics on competition and quality, the theoretical literature in health economics on this topic, and the empirical findings on competition and quality in health care markets are surveyed and their findings assessed.Theory is clear that competition increases quality and improves consumer welfare when prices are regulated (for prices above marginal cost), although the impacts on social welfare are ambiguous. When firms set both price and quality, both the positive and normative impacts of competition are ambiguous. The body of empirical work in this area is growing rapidly. At present it consists entirely of work on hospital markets. The bulk of the empirical evidence for Medicare patients shows that quality is higher in more competitive markets. The empirical results for privately insured patients are mixed across studies"--National Bureau of Economic Research web site.
Book Synopsis Improving Healthcare by : David Hyman
Download or read book Improving Healthcare written by David Hyman and published by Springer Science & Business Media. This book was released on 2007-04-21 with total page 436 pages. Available in PDF, EPUB and Kindle. Book excerpt: Improving Healthcare: A Dose of Competition systematically examines the American health care system from a competition-oriented perspective. The volume surveys the performance of each major sector of the health care system, and identifies impediments to more effective competition. Improving Healthcare examines such issues as competition v. regulation, public and private sector approaches to health care financing, cross-subsidies, licensure, provider market concentration, financial and clinical integration, payment for performance, quality, pharmacy benefit managers, direct-to-consumer advertising of pharmaceuticals, certificates of need, mandates, unionization, the significance of organizational status (nonprofit v. for-profit), and the role of antitrust and consumer protection in health care. It offers concrete recommendations to improve the quality and cost-effectiveness of the American health care marketplace.
Book Synopsis Competition in Health Insurance by : American Medical Association
Download or read book Competition in Health Insurance written by American Medical Association and published by . This book was released on 2013 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt:
