The Challenge Of Regulating Managed Care

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The Challenge of Regulating Managed Care

Author : John Eugene (MD) Billi
Publisher : University of Michigan Press
ISBN 13 : 0472023721
Total Pages : 224 pages
Book Rating : 4.4/5 (72 download)

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Book Synopsis The Challenge of Regulating Managed Care by : John Eugene (MD) Billi

Download or read book The Challenge of Regulating Managed Care written by John Eugene (MD) Billi and published by University of Michigan Press. This book was released on 2010-02-01 with total page 224 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.

Regulating Managed Care

Author : Stuart H. Altman
Publisher : Jossey-Bass
ISBN 13 :
Total Pages : 408 pages
Book Rating : 4.3/5 (91 download)

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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

The Role of Telehealth in an Evolving Health Care Environment

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309262054
Total Pages : 159 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis The Role of Telehealth in an Evolving Health Care Environment by : Institute of Medicine

Download or read book The Role of Telehealth in an Evolving Health Care Environment written by Institute of Medicine and published by National Academies Press. This book was released on 2012-11-20 with total page 159 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

Managed Care

Author :
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834211209
Total Pages : 184 pages
Book Rating : 4.2/5 (112 download)

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Book Synopsis Managed Care by :

Download or read book Managed Care written by and published by Jones & Bartlett Learning. This book was released on 1998 with total page 184 pages. Available in PDF, EPUB and Kindle. Book excerpt: As a result of intense lobbying by consumers and health care providers, managed care organizations are under close scrutiny. More and more frequently, states are taking assertive roles in governing managed care operations, including monitoring how they contract with providers and what types of benefits they provide to enrollees. In this volume, you'll learn how MCOs nationwide are being held accountable to a complex array of new laws -- and what you can expect and demand from MCOs according to new laws.

Managing Managed Care

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309175054
Total Pages : 394 pages
Book Rating : 4.3/5 (91 download)

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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.

Making Sense of Managed Care Regulation in California

Author : Debra L. Roth
Publisher :
ISBN 13 : 9781929008780
Total Pages : 40 pages
Book Rating : 4.0/5 (87 download)

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Book Synopsis Making Sense of Managed Care Regulation in California by : Debra L. Roth

Download or read book Making Sense of Managed Care Regulation in California written by Debra L. Roth and published by . This book was released on 2001-11 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt:

The Private Regulation of American Health Care

Author : Betty Leyerle
Publisher : M.E. Sharpe
ISBN 13 : 9780765636461
Total Pages : 244 pages
Book Rating : 4.6/5 (364 download)

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Book Synopsis The Private Regulation of American Health Care by : Betty Leyerle

Download or read book The Private Regulation of American Health Care written by Betty Leyerle and published by M.E. Sharpe. This book was released on 1994-05-06 with total page 244 pages. Available in PDF, EPUB and Kindle. Book excerpt: I will begin this book by analyzing the historical and political context for the emergence of managed competition (chapter 1). The chapters that follow will list the corporate initiatives that were launched during the 1970s (chapter 2); describe the evolutionary changes and expansions they went through during the 1980s and early 1990s in the process of becoming "managed competition" (chapter 3); describe the ways in which managed care systems attempt to regulate the cost of health care services and discuss why they fail to do so (chapter 4); describe managed care attempts to control the quality of services and discuss why they fail to do so (chapter 5); and conclude with a summary of the book's major points as well as descriptions of some alternative approaches to getting our nation's health care needs met (chapter 6).

The Role of Managed Care Organizations within the Healthcare Industry

Author : Patrick Kimuyu
Publisher : GRIN Verlag
ISBN 13 : 3668627614
Total Pages : 19 pages
Book Rating : 4.6/5 (686 download)

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Book Synopsis The Role of Managed Care Organizations within the Healthcare Industry by : Patrick Kimuyu

Download or read book The Role of Managed Care Organizations within the Healthcare Industry written by Patrick Kimuyu and published by GRIN Verlag. This book was released on 2018-02-01 with total page 19 pages. Available in PDF, EPUB and Kindle. Book excerpt: Seminar paper from the year 2018 in the subject Medicine - Medical Frontiers and Special Areas, grade: 1, Egerton University, language: English, abstract: This paper will provide a comprehensive overview of managed care, primarily on the advantages and disadvantages of managed care organizations. Over the decades, the United States’ healthcare system has been experiencing challenges. In general, the cost and quality of care has always been considered as the most critical factors that influence healthcare sustainability in the United States and the world, as a whole. As a result, a series of value-based payment reforms have been introduced. For instance, the Affordable Care Act (ACA) of 2010 introduced payment and delivery system reforms. From a critical perspective, the reforms introduced by the ACA have addressed the long-standing problems which have been posing enormous hindrances to the development of the U.S. healthcare system. Above all, it has enhanced managed care through consolidating care, as well as, addressing the problem of unsustainable costs and uneven quality of care. However, managed care seems to exhibit some drawbacks too.

Managed Care and Monopoly Power

Author : Deborah HAAS-WILSON
Publisher : Harvard University Press
ISBN 13 : 0674038118
Total Pages : 251 pages
Book Rating : 4.6/5 (74 download)

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Book Synopsis Managed Care and Monopoly Power by : Deborah HAAS-WILSON

Download or read book Managed Care and Monopoly Power written by Deborah HAAS-WILSON and published by Harvard University Press. This book was released on 2009-06-30 with total page 251 pages. Available in PDF, EPUB and Kindle. Book excerpt: As millions of Americans are aware, health care costs continue to increase rapidly. Much of this increase in health care costs is due to the development of new life-sustaining drugs and procedures, but part of it is due to the increased monopoly power of physicians, insurance companies, and hospitals, as the health care sector undergoes reorganization and consolidation. There are two tools to limit the growth of monopoly power: government regulation and antitrust policy. In this timely book, Deborah Haas-Wilson argues that enforcement of the antitrust laws is the tool of choice in most cases. Focusing on the economic concepts necessary to the enforcement of the antitrust laws in health care markets, Haas-Wilson provides a useful roadmap for guiding the future of these markets.

Care Without Coverage

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309083435
Total Pages : 213 pages
Book Rating : 4.3/5 (9 download)

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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.

Managed Competition

Author :
Publisher : DIANE Publishing
ISBN 13 : 9780788100260
Total Pages : 120 pages
Book Rating : 4.1/5 (2 download)

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Book Synopsis Managed Competition by :

Download or read book Managed Competition written by and published by DIANE Publishing. This book was released on 1993-07 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pamphlet from the vertical file.

Ethical Challenges in Managed Care

Author : Karen Grandstrand Gervais
Publisher :
ISBN 13 :
Total Pages : 392 pages
Book Rating : 4.F/5 ( download)

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Book Synopsis Ethical Challenges in Managed Care by : Karen Grandstrand Gervais

Download or read book Ethical Challenges in Managed Care written by Karen Grandstrand Gervais and published by . This book was released on 1999 with total page 392 pages. Available in PDF, EPUB and Kindle. Book excerpt: Through twenty case studies that illustrate a wide range of ethical challenges, this book explores the goals, methods, and practices of managed care, and offers practical guidance for addressing the ethical and policy issues inherent in such a system.

Competitive Managed Care

Author : John D. Wilkerson
Publisher : Jossey-Bass
ISBN 13 :
Total Pages : 438 pages
Book Rating : 4.:/5 (321 download)

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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.

Federalism and Health Policy

Author : Alan Weil
Publisher : The Urban Insitute
ISBN 13 : 9780877667162
Total Pages : 448 pages
Book Rating : 4.6/5 (671 download)

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Book Synopsis Federalism and Health Policy by : Alan Weil

Download or read book Federalism and Health Policy written by Alan Weil and published by The Urban Insitute. This book was released on 2003 with total page 448 pages. Available in PDF, EPUB and Kindle. Book excerpt: The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.

Health Professions Education

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 030913319X
Total Pages : 191 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Health Professions Education by : Institute of Medicine

Download or read book Health Professions Education written by Institute of Medicine and published by National Academies Press. This book was released on 2003-07-01 with total page 191 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.

Integrating Managed Care and Ethics

Author : Dennis A. Robbins
Publisher : McGraw-Hill Professional Publishing
ISBN 13 :
Total Pages : 376 pages
Book Rating : 4.4/5 (91 download)

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Book Synopsis Integrating Managed Care and Ethics by : Dennis A. Robbins

Download or read book Integrating Managed Care and Ethics written by Dennis A. Robbins and published by McGraw-Hill Professional Publishing. This book was released on 1998 with total page 376 pages. Available in PDF, EPUB and Kindle. Book excerpt: Integrating Managed Care and Ethics addresses legal and ethical challenges that arise in managed care and includes a discussion of trends, alluding to recent legislative/ regulatory initiatives, major legal cases, and examines guidance offered through several of the major healthcare trade associations. Its goal is to help the reader develop increased talent, tools, and techniques to help transform challenges and change into more positive outcomes.

Model Rules of Professional Conduct

Author : American Bar Association. House of Delegates
Publisher : American Bar Association
ISBN 13 : 9781590318737
Total Pages : 216 pages
Book Rating : 4.3/5 (187 download)

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Book Synopsis Model Rules of Professional Conduct by : American Bar Association. House of Delegates

Download or read book Model Rules of Professional Conduct written by American Bar Association. House of Delegates and published by American Bar Association. This book was released on 2007 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.