Controlling Costs and Changing Patient Care?

The Role of Utilization Management

Author: Institute of Medicine

Publisher: National Academies Press

ISBN:

Category: Medical

Page: 328

View: 654

Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate. This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.

Controlling Costs and Changing Patient Care?

The Role of Utilization Management

Author: Institute of Medicine

Publisher: National Academies Press

ISBN:

Category: Medical

Page: 328

View: 904

Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate. This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.

The Profit Motive and Patient Care

The Changing Accountability of Doctors and Hospitals

Author: Bradford H. Gray

Publisher: Harvard University Press

ISBN:

Category: Medical

Page: 456

View: 456

In this penetrating analysis, Bradford Gray tackles the thorny issues surrounding the question of to whom and for what our physicians and hospitals are accountable. This book provides a careful evaluation of the mechanisms of accountability that have developed along with a growing profit orientation of health care, and it alerts us to keep a sharp eye focused on who is looking out for the interests of the patient.

Changing Health Care Systems and Rheumatic Disease

Author: Committee on Changing Health Care Systems and Rheumatic Disease

Publisher: National Academies Press

ISBN:

Category: Medical

Page: 225

View: 186

Market forces are driving a radical restructuring of health care delivery in the United States. At the same time, more and more people are living comparatively long lives with a variety of severe chronic health conditions. Many such people are concerned about the trend toward the creation of managed care systems because their need for frequent, often complex, medical services conflicts with managed care's desires to contain costs. The fear is that people with serious chronic disorders will be excluded from or underserved by the integrated health care delivery networks now emerging. Responding to a request from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, this book reflects the results of a workshop that focused on the following questions: Does the model of managed care or an integrated delivery system influence the types of interventions provided to patients with chronic conditions and the clinical and health status outcomes resulting from those interventions? If so, are these effects quantitatively and clinically significant, as compared to the effects that other variables (e.g., income, education, ethnicity) have on patient outcomes? If the type of health care delivery system appears to be related to patient care and outcomes, can specific organizational, financial, or other variables be identified that account for the relationships? If not, what type of research should be pursued to provide the information needed about the relationship between types of health care systems and the processes and outcomes of care provided to people with serious chronic conditions?

Expanding Health Insurance Coverage and Controlling Costs for Health Care

Testimony Before the Committee on the Budget, U. S. Senate

Author: Douglas W. Elmendorf

Publisher: DIANE Publishing

ISBN:

Category:

Page: 31

View: 318

Testimony on the opportunities and challenges that the Congress faces in pursuing two major policy goals: (1) expanding health insurance coverage, so that more Americans receive appropriate health care without undue financial burden; and (2) making the health care system more efficient, so that it can continue to improve Americans¿ health but at a lower cost in both the public and private sectors. Both are complex endeavors in their own right, and interactions and trade-offs between them may arise.

Health Services

Sources of Information for Research

Author:

Publisher:

ISBN:

Category: Medical care

Page: 201

View: 443

Guide to aid users and producers of health services research in accessing relevant literature and sources of information. Includes dictionaries, directories, monographs and bibliographies, journals, abstracts and indexes, online and CD-ROM databases, and organizations.

Health Care for the Uninsured

Hearings Before the Subcommittee on Health for Families and the Uninsured of the Committee on Finance, United States Senate, One Hundred First Congress, First Session, June 19, 1989 (Washington, DC), June 28, 1989 (Southfield, MI).

Author: United States. Congress. Senate. Committee on Finance. Subcommittee on Health for Families and the Uninsured

Publisher:

ISBN:

Category: Health insurance

Page:

View: 609

Managing Managed Care

Quality Improvement in Behavioral Health

Author: Institute of Medicine

Publisher: National Academies Press

ISBN:

Category: Medical

Page: 396

View: 316

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 health--federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

The Law of Health Care Organization and Finance

Author: Barry R. Furrow

Publisher: West Academic

ISBN:

Category: Law

Page: 769

View: 804

A spin-off publication of Health Law: Cases, Materials & Problems, 5th Edition, the text begins with an introduction to fundamental concepts affecting law and policy. The next chapter considers quality control in the health care setting. The following four chapters examine issues central to structuring integrated systems and the organization of health care institutions. It also covers the problem of health care access and cost control issues, with particular attention paid to the ongoing policy debate about the proper role of government and the nation's responsibilities to provide health care for indigent citizens. Examines legal oversight of private health financing, and looks at Medicare and Medicaid.

Health Care Reform

Hearing Before the Committee on Energy and Commerce, House of Representatives, One Hundred Third Congress, First Session, on President Clinton's Proposal to Reform the Nation's Health Care System

Author: United States. Congress. House. Committee on Energy and Commerce

Publisher:

ISBN:

Category: Health care reform

Page:

View: 863

Holding Health Care Accountable

Law and the New Medical Marketplace

Author: E. Haavi Morreim

Publisher: Oxford University Press

ISBN:

Category: Medical

Page: 336

View: 233

Health care in the US and elsewhere has been rocked by economic upheaval. Cost-cuts, care-cuts, and confusion abound. Traditional tort and contract law have not kept pace. Physicians are still expected to deliver the same standard of care -- including costly resources - to everyone, regardless whether it is paid for. Health plans can now face litigation for virtually any unfortunate outcome, even those stemming from society's mandate to keep costs down while improving population health. This book cuts through the chaos and offers a clear, persuasive resolution. Part I explains why new economic realities have rendered prevailing malpractice and contract law largely anachronistic. Part II argues that pointing the legal finger of blame blindly or hastily can hinder good medical care. Instead of "whom do we want to hold liable," we should focus first on "who should be doing what, for the best delivery of health care." When things go wrong, each should be liable only for those aspects of care they could and should have controlled. Once a good division of labor is identified, what kind of liability should be imposed depends on what kind of mistake was made. Failures to exercise adequate expertise (knowledge, skill, care effort) should be addressed as torts, while failures to provide promised resources should be resolved under contract. Part III shows that this approach, though novel, fits remarkably well with basic common law doctrines, and can even enlighten ERISA issues. With extensive documentation from current case law, commentary, and empirical literature, the book will also serve as a comprehensive reference for attorneys, law professors, physicians, administrators, bioethicists, and students.

Protecting the U.S. Population’s Health Against Potential Economic Recessions and High Unemployment and the Endemic Inflation of Health Care Costs

Author: Fritz Dufour

Publisher: Fritz Dufour

ISBN:

Category: Medical

Page: 307

View: 354

This book has three main parts: (1) the challenges of the U.S. health care system; (2) the impacts of economic recessions and high unemployment on the U.S. population’s health; and (3) recommendations or a look into what might improve the health care system. Part I, through a dissection of the challenges faced by the U.S. health care system, exposes the particularities and the vulnerabilities of the system. It shows the role played by businesses and employment in the U.S. population’s health and describes major challenges of the health care system such as astronomical health care costs, the average family health spending – which is exceedingly high, wasteful spending, death due to inaccessibility to health care, and the hardships that medical costs created for more than half of Americans. Part II is an analysis as to why do economic recessions have health implications. That analysis is done by considering the health implications of economic recessions both at the micro and macroeconomic levels and by considering the societal costs of uninsurance or inaccessibility to health care due to economic recessions and high unemployment. Part III primarily focuses on what can make the system better, that is more efficient and more cost-effective. Ironically, as Part III argues, there are a myriad of feasible recommendations that are waiting to be fully explored, agreed upon, adopted and implemented nationwide: · Design labor and fiscal policies aimed at preventing economic recessions and high unemployment o Blend labor and fiscal policies into structural reforms · Create job security and take other steps that guarantee health care security during financial hardship · Improve health outcomes through nationwide permanent supportive housing to combat chronic homelessness during economic recessions and high unemployment · Prioritize the use of more cost-effective medical technologies o Promote telemedicine to reduce costs and improve accessibility to health care · Eliminate health disparities thanks to the democratization of health care · Promote health literacy and the valorization of communities · Design policies or procedures that 1) promote health care costs reduction and efficiency through affordable insurance coverage and 2) eliminate Wasteful spending: o Extend drug coverage and implement cost-effective pricing policies o Extend coverage of more medical procedures and implement cost-effective policies On the other hand, Part III also sells the idea of a thorough and bold revolution in our health care system, which would make health care a right of citizenship. It does so by analyzing the political, social, ethical, and economic aspects of the issue. Furthermore, it argues that the relationship between universal health care and economics justifies the notion of “health care as a right of citizenship.”

The Clinician's Guide to Managed Behavioral Care

Second Edition of The Clinician's Guide to Managed Mental Health Care

Author: William Winston

Publisher: Routledge

ISBN:

Category: Business & Economics

Page: 332

View: 321

Managed care is a revolution impacting the practice of clinicians throughout America. The Clinician’s Guide to Managed Behavioral Care, called “a survival kit” and “must reading,” helps clinicians develop and market professional services attuned to the needs of managed care systems, manage the utilization process, and reshape an office practice or hospital-based program to become more “managed care friendly.” It is newly referenced and updated for clinicians to continue to advocate for their patients and clients. The Clinician’s Guide to Managed Behavioral Care addresses how clinicians can develop and market professional services attuned to the needs of managed care systems, how to best manage the utilization review process, how to re-shape an office practice or hospital-based program to become more “managed care friendly,” and how to best advocate for patients and clients. Readers will understand the history and evolution of attempts to manage mental health care costs and services as well as the emerging clinical, economic, and social trends that will continue to fuel changes in the mental health field in coming years. Importantly, this guide sensitizes readers to the perspectives about mental health care benefits and the treatment field held by the payor community--insurance carriers, HMO’s, and self-insured employers. It allows readers to consider a payor’s view of how professionals can play a crucial role in providing quality services while helping control spiraling mental health care costs--costs that have escalated much faster than other segments of health care. Who can benefit from this book? Practicing psychologists, social workers, psychiatrists, substance abuse counselors, marriage and family therapists, Employee Assistance Professionals, psychiatric nurses, professional counselors, program managers, hospital administrators, and health care marketing professionals will find The Clinician’s Guide to Managed Behavioral Care and invaluable resource. It is often said that in the future, all in the treatment community will be involved in “managing care” and that the most successful clinicians and practices will be those most adept at working with managed care systems on behalf of their patients and clients. This book helps you understand how! Important topics in The Clinician’s Guide to Managed Behavioral Care: the changing marketplace for mental health/substance abuse treatment services assessing market opportunities in light of managed care influences clinical service needs of managed care systems clinical innovations: examples, case studies, vignettes strategies for managing utilization review marketing strategies for office-based practitioners hospital-managed care partnerships contemporary office management strategies to control costs consumers and managed care directory of America’s HMOs directory of America’s Managed Mental Health Care Companies glossary of key terms

The Impact of Managed Care on the Practice of Psychotherapy

Innovation, Implementation, and Controversy

Author: Richard M. Alperin

Publisher: Psychology Press

ISBN:

Category: Social Science

Page: 243

View: 471

What is new and different about psychotherapy practice under managed care? How does managed care affect treatment delivery? Why do many psychotherapists object to managed care? In this important new book, Drs. Alperin and Phillips have invited experts at the forefront of the mental health field, representing a wide variety of backgrounds, to answer these and many other questions regarding the impact of managed care on the practice of psychotherapy.

Encyclopedia of Health Services Research

Ed. by Ross M. Mullner

Author: Ross M. Mullner

Publisher: SAGE

ISBN:

Category: Medical

Page: 1456

View: 105

At the very heart of modern healthcare is a critical paradox. Today, as never before, healthcare has the ability to enhance the quality and duration of life. At the same time, healthcare has become so enormously costly that it can easily bankrupt governments and impoverish individuals and families. According to federal forecasters, by the year 2015 one in every five U.S. dollars will be spent on healthcare, for total annual healthcare spending of more than $4 trillion. While the cost of healthcare is going up, the number of individuals and families without health insurance coverage is increasing. For many, the miracles of modern medicine may be unaffordable. Health services research investigates the relationship between the factors of cost, quality, and access to healthcare and their impact upon medical outcomes (i.e., death, disease, disability, discomfort, and dissatisfaction with care). Health services research addresses such key questions as, Why is the cost of healthcare always increasing? How can healthcare costs be successfully contained without jeopardizing quality? How can medical errors be eliminated? What is the medical impact of not having health insurance coverage? The proposed encyclopedia addresses these and other important questions and issues.