The managed care blues and how to cure them:
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Book |
| Language: | English |
| Published: |
Washington, D.C.
Georgetown Univ. Press
1998
|
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XVI, 224 S. graph. Darst. |
| ISBN: | 0878406794 0878406808 |
Staff View
MARC
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Record in the Search Index
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| adam_text | Contents
Preface xi
Two Authors, Different Experiences x Defending and Critiquing
Managed Care xiii
American Health Care:
Yesterday, Today and Tomorrow 1
The Long and Winding Road
The Old Non System 6 The Logic of Managed Care 8
Managed Care under Attack 10 Fulfilling the Promise 12
Strategies for the Future 14
1
The Failure of the Old Insurance System 16
The Thrill is Gone
It Worked for All, except... 17 No Invisible Hand 18
The Tax Man Subsidizeth 20 Weak Buyers and Unique
Markets 21 The Costs of Scientific Advance 22 Self Insurance
and the First Hand Experience 23 Markets and Trade offs 23
No Contest: The Government versus Costs 25 Controlling Costs,
Expanding Services 26 The Government versus Providers 27
Costly Compromises: The Birth of Medicare 28 Price Controls:
The Nixon Years 30 Providers Win a Pyrrhic Victory 31
Reinventing Medicare 32
| vii
viii | Contents
2
Quality in the Old System: Not What We
Thought 35
I ve Been Loving You Too Long
Professionalism Will Do the Job 36 The Cottage Industry Cannot
Adjust 37 Accountability 38 Practice Variation 39
The Information Explosion 42 Tolerance of Errors 43
Too Much Focus on Disease, Not Enough on Health 45
What Role for Professionalism? 46
3
The Rise of Managed Care 49
Birth of the Blues
Early Opposition 50 The 1970s and the Health Maintenance
Organization 51 The Rise of HMOs and the Loss of Physician
Domination 53 Managed Care Diversifies 55 New Niches and
New Products 57 From Minority to Majority Status 60
The Trends Converge 61 The Clinton Plan: Managed Care and
Markets Emerge Victorious 62
4
The Tools of Managed Care 64
You Can t Always Get What You Want
The Logic of Managed Care 65 A Taxonomy of Managed Care 66
Managed Care s Tool Box 68 Utilization Management and
Preauthorization 73 The Tools in Action 82 Conclusion 86
5
The Cutting Edge of Quality Improvement 87
Good Vibrations
Quality Improvement Programs and Practice Guidelines 88
Demand Management 91 Programs for the Catastrophically and
2TSr9 93 th ^^ Mana* *nt 94 Specialty Benefit
Carve Outs 97 The Logic of Managed Care Meets Reality 98
Contents | ix
6
The Managed Care Backlash 102
Stop in the Name of Love
Dissecting the Horror Story 105 Consumer Concerns: Who
Comes First? 108 Choice, Access, and Quality 111 The Greed
Factor 112 The Physician Backlash 115 Conclusion: Consumers
at Risk 117
7
The Managed Care Record: Better Than
You Think 119
Sympathy for the Devil
It Costs Less, and That Counts 120 Blame the System 121
Exaggerated Fears 123 Too Broad a Brush 126
Misunderstanding Value 128 Quality in Managed Care: What We
Know and Don t Know 129 Consumer Satisfaction 134
Quality in Managed Care: They re Both Wrong 135
8
Rule of Price; Cult of Choice; Cost of Quality 137
You Better Shop Around
The Components of Value 137 Price: The Bottom Line Rules 139
Choice: of Physician, Plan, and Other Things 141 Quality:
The Stepchild 151 Summary 158
9
Protecting the Floor 160
They Can t Take that Away from Me
Consumer Protection: Two Approaches 160
Approaches to Protecting the Floor: Some Wise, Some Not 162
X I Contents
10
Thirteen Steps to Raising Quality in
Managed Care 179
With a Little Help from My Friends
1. From Employer to Employee Choice 179 2. Expanding
Consumer Choice to Delivery Systems, Not Just Insurers 182
3. Enhancing the Power of the Purchaser 183 4. Toward More
Cost Conscious Consumers 186 5. Getting Sophisticated: The
Subtler Health Care Trade Offs 188 6. Improving the Ability to
Choose: The Information Revolution, Part One 189 7. Improving
Clinical Performance: The Information Revolution, Part Two 193
8. From Opposition to Leadership: The Role of Physicians 193
9. Toward Greater Health Plan Liability: Another Approach to
Malpractice 195 10. Consolidation vs. Integration: An Antitrust
Challenge 196 11. Competing on Quality: The Devil in the
Details 197 12. A National Report on Health Care Quality 199
13. From Traditional Regulation to the Bully Pulpit 200
Epilogue 203
Bridge Over Troubled Water
References 205
Index 213
|
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| spelling | Zelman, Walter A. Verfasser aut The managed care blues and how to cure them Walter A. Zelman ; Robert A. Berenson Washington, D.C. Georgetown Univ. Press 1998 XVI, 224 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Health insurance United States Insurance, Health United States Managed Care Programs United States Managed care plans (Medical care) United States Managed Care (DE-588)4461436-6 gnd rswk-swf Gesundheitspolitik (DE-588)4113743-7 gnd rswk-swf USA USA (DE-588)4078704-7 gnd rswk-swf USA (DE-588)4078704-7 g Managed Care (DE-588)4461436-6 s Gesundheitspolitik (DE-588)4113743-7 s DE-604 Berenson, Robert A. Verfasser aut HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008744302&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Zelman, Walter A. Berenson, Robert A. The managed care blues and how to cure them Health insurance United States Insurance, Health United States Managed Care Programs United States Managed care plans (Medical care) United States Managed Care (DE-588)4461436-6 gnd Gesundheitspolitik (DE-588)4113743-7 gnd |
| subject_GND | (DE-588)4461436-6 (DE-588)4113743-7 (DE-588)4078704-7 |
| title | The managed care blues and how to cure them |
| title_auth | The managed care blues and how to cure them |
| title_exact_search | The managed care blues and how to cure them |
| title_full | The managed care blues and how to cure them Walter A. Zelman ; Robert A. Berenson |
| title_fullStr | The managed care blues and how to cure them Walter A. Zelman ; Robert A. Berenson |
| title_full_unstemmed | The managed care blues and how to cure them Walter A. Zelman ; Robert A. Berenson |
| title_short | The managed care blues and how to cure them |
| title_sort | the managed care blues and how to cure them |
| topic | Health insurance United States Insurance, Health United States Managed Care Programs United States Managed care plans (Medical care) United States Managed Care (DE-588)4461436-6 gnd Gesundheitspolitik (DE-588)4113743-7 gnd |
| topic_facet | Health insurance United States Insurance, Health United States Managed Care Programs United States Managed care plans (Medical care) United States Managed Care Gesundheitspolitik USA |
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