Journal articles: 'Managed care health insurance'

1

Light, Donald W. "Good Managed Care Needs Universal Health Insurance." Annals of Internal Medicine 130, no. 8 (April 20, 1999): 686. http://dx.doi.org/10.7326/0003-4819-130-8-199904200-00016.

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Albert Ma, Ching-To, and Michael H. Riordan. "Health Insurance, Moral Hazard, and Managed Care." Journal of Economics Management Strategy 11, no. 1 (March 2002): 81–107. http://dx.doi.org/10.1111/j.1430-9134.2002.00081.x.

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Watzman, Nancy, and Patrick Woodall. "Managed Health Care Companies' Lobbying Frenzy." International Journal of Health Services 25, no. 3 (July 1995): 403–10. http://dx.doi.org/10.2190/g11p-26yf-dq6j-ekhv.

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The top dozen national managed health care companies and two industry trade groups spent at least $2,023,041 on lobbying expenses and campaign contributions to key lawmakers during last year's health care debate, according to an analysis of Federal Election Commission data and federal lobbying disclosure forms. Five of the top six spenders are large insurance companies that are rapidly transferring their business from traditional indemnity insurance to HMOs. Over half—52 percent—of campaign donations from the top managed care companies' and trade associations' PACs and employees went to members sitting on the five Congressional committees with jurisdiction over health care reform.

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Kucsan, Bernice. "Managed Care: A “New” Wave in Health Care Insurance?" Journal For Healthcare Quality 11, no. 3 (June 1989): 18–19. http://dx.doi.org/10.1111/j.1945-1474.1989.tb00414.x.

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Relman, Arnold S. "Medical Insurance and Health -- What about Managed Care?" New England Journal of Medicine 331, no. 7 (August 18, 1994): 471–72. http://dx.doi.org/10.1056/nejm199408183310711.

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Litaker, David, and Randall D. Cebul. "Managed Care Penetration, Insurance Status, and Access to Health Care." Medical Care 41, no. 9 (September 2003): 1086–95. http://dx.doi.org/10.1097/01.mlr.0000083741.80192.e0.

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Ozminkowski, R. J., M. Noether, P. Nathanson, K. M. Smith, B. E. Raney, D. Mickey, and P. M. Hawley. "Profiling Primary Care Physicians for a New Managed Care Network." Health Services Management Research 10, no. 3 (August 1997): 173–86. http://dx.doi.org/10.1177/095148489701000304.

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We developed methods for comparing physicians who would be selected to participate in a major employer's self-insurance program. These methods used insurance claims data to identify and profile physicians according to deviations from prevailing practice and outcome patterns, after considering differences in case-mix and severity of illness among the patients treated by those providers. The discussion notes the usefulness and limitations of claims data for this and other purposes. We also comment on policy implications and the relationships between our methods and health care reform strategies designed to influence overall health care costs.

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Cheng, Shou-Hsia, Chih-Ming Chang, Chi-Chen Chen, Chih-Yuan Shih, and Shu-Ling Tsai. "Half-Managed Care." International Journal of Health Services 47, no. 3 (November 19, 2015): 519–31. http://dx.doi.org/10.1177/0020731415615310.

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In 2011, a novel capitation program was launched in Taiwan under its universal health insurance plan. This study aimed to assess the short-term impact of the program. Two hospitals in the greater Taipei area, one participating in the “loyal patient” model (13,319 enrollees) and one in the “regional resident” model (13,768 enrollees), were analyzed. Two comparison groups were selected by propensity score matching. Generalized estimating equation models with differences-in-differences analysis were used to examine the net effects of the capitation program on health care utilization, expenses, and outcomes. Enrollees in the loyal patient model had fewer physician visits in the host hospital, but more physician visits outside that hospital during the program year than they had the year before. Compared with non-enrollees, the loyal patient model enrollees incurred fewer physician visits (β = −0.042, p < .001), fewer emergency department visits, (β = −0.140, p < .001), and similar total expenses and outcome. For the regional resident model, no differences were found in the number of physician visits, expenses, or outcomes between enrollees and non-enrollees. The novel capitation models in Taiwan had minimal impact on health care utilization after 1 year of implementation and the health care outcome was not compromised.

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Chapin, Christy Ford. "The American Medical Association, Health Insurance Association of America, and Creation of the Corporate Health Care System." Studies in American Political Development 24, no. 2 (August 23, 2010): 143–67. http://dx.doi.org/10.1017/s0898588x10000052.

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This narrative demonstrates how public and private power interacted during the post–World War II era to create America's unique health care system, a system based on a high-cost, corporate model financed and managed by insurance companies. The article compares the divergent political, organizational, and economic strategies of the American Medical Association (AMA), which represented physicians, and the Health Insurance Association of America (HIAA), which represented for-profit insurance firms. Even after the defeat of President Harry Truman's plan for a universal, government-managed system, policymakers in both parties attempted to reform the health care market, because most observers recognized that the embryonic insurance-company-funded model had inherent cost problems. In order to defeat numerous reform proposals, AMA and HIAA leaders allied to rapidly develop the market around insurance-company financing. Insurers and physicians constructed overlapping institutions to manage their increasingly close financial relationship, thus creating a pseudocorporate arrangement. In an attempt to control costs, insurance companies expanded their function beyond simply underwriting the risks associated with medical services consumption to also assuming a supervisory role, albeit distant, over health care delivery. When policymakers designed Medicare, they adopted the organizational framework that private health interests had already created, thereby legitimizing the previously contested high-cost model.

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Mulligan, Kate. "Managed Care Has Not Solved Health Insurance Cost Problems." Psychiatric News 36, no. 18 (September 21, 2001): 14–28. http://dx.doi.org/10.1176/pn.36.18.0014a.

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11

Shearer, Gail. "Managed Competition: An Analysis of Consumer Concerns." International Journal of Health Services 24, no. 1 (January 1994): 11–24. http://dx.doi.org/10.2190/4pl1-hrrk-laf0-31ey.

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Advocates for health care reform (representing a broad range of constituencies) raise serious concerns about the ability of managed competition to meet the health care needs of the American people. Similarities in managed competition proposals include establishment of a collective purchasing authority, creation of health plans, standardization of rules and requirements, and limitation on tax subsidies. Managed competition proposals vary as to whether they call for true universality, meaningful cost containment, and fair financing. The article raises questions about managed competition, including the technical feasibility; the link to employment; the role for insurance companies; severing the link between insurance and income, age, or health status; comprehensive benefits; cost containment; the role for managed care; universality of coverage; and the role for insurance companies to make treatment decisions.

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12

Hoffman, Beatrix. "Restraining the Health Care Consumer." Social Science History 30, no. 4 (2006): 501–28. http://dx.doi.org/10.1017/s0145553200013560.

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Health insurance with high deductibles is an important feature of the Bush administration's health savings accounts initiative. A similar type of insurance, known as major medical, was the most common type of health coverage in the United States from the 1950s through the 1970s. This article traces the history of cost sharing in health insurance from its origins in insurers' concerns about “moral hazard” to the heyday of major medical insurance to the temporary comeback of first-dollar coverage during the era of managed care. Proponents of deductibles and co-payments, today and in the past, have argued that they bring down costs by forcing consumers to make more careful health care choices. The history of major medical insurance, however, shows that high-deductible insurance failed to curb medical inflation and also hurt consumers who expected their coverage to protect their incomes from the costs of sickness and injury.

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Gilchrist, Barbara J. "Managed Care Takes to the Highway: Implications for Insureds." Journal of Law, Medicine & Ethics 29, no. 2 (2001): 203–19. http://dx.doi.org/10.1111/j.1748-720x.2001.tb00341.x.

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Automobile insurance companies are joining the move to managed care in the hopes of reducing health-care expenditures arising out of automobile accidents. Industry interest is strong enough that large managed care organizations, such as Concentra Managed Care, Inc., and HNC Insurance Solutions, are beginning to offer their existing network of providers to persons seeking medical care for automobile accident injuries and their evaluation software to insurers.While insurance companies have successfully pressed four state legislatures and one commissioner of insurance for authorization to offer consumers a managed care option in automobile insurance policies, these efforts have not gone unchallenged. Vocal opponents, primarily lawyer and chiropractic organizations, question whether persons injured in accidents will receive care when needed (especially if the accident occurs when the policyholder is away from home), what the quality of care received will be, and whether any savings will be passed on to consumers.

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14

Grazier, Kyle L. "Structuring Managed Care: Lessons from Traditional Insurance." Journal of Healthcare Management 44, no. 2 (March 1999): 87–90. http://dx.doi.org/10.1097/00115514-199903000-00004.

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15

Tamura, Makoto. "Managed Care Introduced to the US Social Health Insurance System." Iryo To Shakai 8, no. 4 (1999): 73–88. http://dx.doi.org/10.4091/iken1991.8.4_73.

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16

Weiner, Jonathan P., Joanna Case Famadas, Hugh R. Waters, and Djordje Gikic. "Managed Care and Private Health Insurance in a Global Context." Journal of Health Politics, Policy and Law 33, no. 6 (November 26, 2008): 1107–31. http://dx.doi.org/10.1215/03616878-2008-034.

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17

Greengold, R. H. "Managed Care vs Universal Health Insurance: Whose Whips Are Gentler?" Archives of Internal Medicine 160, no. 11 (June 12, 2000): 1704—a—1705. http://dx.doi.org/10.1001/archinte.160.11.1704-a.

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18

Backus, Lisa I., and Andrew B. Bindman. "Low-Income Californians' Experiences With Health Insurance and Managed Care." Journal of Health Care for the Poor and Underserved 12, no. 4 (2001): 446–60. http://dx.doi.org/10.1353/hpu.2010.0801.

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19

Bhaskar, Rahul, and Au Vo. "Health Care Reform Requires IT Solutions to Influence Consumer Perception at a Health Care Payer." Journal of Cases on Information Technology 14, no. 2 (April 2012): 18–26. http://dx.doi.org/10.4018/jcit.2012040102.

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The recent health care reform is one of the biggest changes that the health care industry has ever faced. This reform represents the paradigm changing opportunities and challenges for the company providing health insurance in a managed care environment. The CIO of a premier managed care health insurance provider (“ABC Company”) wants to take advantage of the new environment using Information Technology. He and his management teams have determined, using primary research, that the customer perception of the health care company’s cost and accessibility to the quality health care are the most important factors to their customers in the new market. They are aware that even though they have been able to use information technology to predict customer reaction to the changes in cost, and perception of quality, it will be very difficult to deliver new systems and processes that support ABC Company’s to the new realities it is facing the market.

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20

Akinci, F., and T. Sinay. "Perceived access in a managed care environment: determinants of satisfaction." Health Services Management Research 16, no. 2 (May 1, 2003): 85–95. http://dx.doi.org/10.1258/095148403321591401.

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With increasing competition in the local and regional healthcare markets, and growing interest in assessing the effectiveness of services and patient outcomes, satisfaction measures are becoming prominent in evaluating the performance of the healthcare system. This study examines the independent effect of predisposing, enabling and medical need factors on perceived access to care with particular focus on insurance plans. A survey questionnaire is developed to investigate access limitations at three levels: (1) the health plan, (2) the individual provider(s) and (3) the healthcare organization. In addition, shortage of providers, residents' perceptions of their health status, satisfaction with access to care and socio-demographic indicators are incorporated into the analysis. Multivariate logistic regression is used to assess the independent effects of the above factors on a dichotomous dependent variable - residents' overall satisfaction with access to healthcare services. The most salient determinants of overall satisfaction with access to care were the type of health insurance plan, cost of insurance premiums, co-payments, difficulty with obtaining referrals, self-rated general health, the opportunity cost of taking time to see a provider (measured by the loss of hourly wages), marital status and the age factor over 80 years.

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21

Popp, E. "The calculation of managed care tariffs in the compulsory health insurance." Insurance: Mathematics and Economics 22, no. 2 (June 1998): 188. http://dx.doi.org/10.1016/s0167-6687(98)80041-3.

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22

Kifmann, Mathias. "Community rating and choice between traditional health insurance and managed care." Health Economics 8, no. 7 (November 1999): 563–78. http://dx.doi.org/10.1002/(sici)1099-1050(199911)8:7<563::aid-hec477>3.0.co;2-a.

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Okma, Kieke GH. "Will Dutch-style managed competition work in the Irish health system?" Volume 4 Issue 1 (2012) 4, no. 1 (January 1, 2012): 40. http://dx.doi.org/10.33178/ijpp.4.1.6.

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In early 2011 the new Irish government announced its intention to implement a model of "managed competition" inspired by the Dutch insurance reform of 2006 (Ryan and Mikkers 2011). This is to replace the central role of government in financing and providing health care services with a system of competing health insurers who are to contract health care services on behalf of their insured. The assumptions of "managed competition" (or “consumer-driven health care“) are fourfold: that health insurers are willing and able to selectively contract and pay hospitals and other health care providers; that providers are keen to offer better and cheaper care than their competitors; and that insured and patients will act as well-informed and critical consumers in selecting the insurance plan that best fits their needs; and that governments will (mostly) keep their hands off and let the market do the work in allocating scare health resources efficiently (see Enthoven and Van de Ven 2007; Bernstein 2011). Full Opinion piece pending final approval

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24

Gabel, Jon R., Gail A. Jensen, and Samantha Hawkins. "Self-Insurance In Times Of Growing And Retreating Managed Care." Health Affairs 22, no. 2 (March 2003): 202–10. http://dx.doi.org/10.1377/hlthaff.22.2.202.

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Himmelstein, David U., Steffie Woolhandler, and Clare Fauke. "U.S. Health Care in the Trump Era: A Data Update." International Journal of Health Services 49, no. 3 (April 8, 2019): 402–11. http://dx.doi.org/10.1177/0020731419840178.

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We present a summary of recent studies and data regarding the state of health and health care in the United States. Health care remains unaffordable to many Americans, including many with insurance. Health outcomes are stagnating or deteriorating. Police killings disproportionately target minority men. The search for profits from prescription drug companies, medical device firms, and for-profit medical providers places patients at risk. The public Medicare and Medicaid insurance programs, which increasingly subcontract with private managed care insurers, now account for the majority of private insurers’ total business. Insurance firms continue to avoid unprofitable enrollees and impose a mounting bureaucratic burden on medical providers. Meanwhile, recent polls show mounting public support for single-payer national health insurance.

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Miller, Grant, Diana Pinto, and Marcos Vera-Hernández. "Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor." American Economic Journal: Applied Economics 5, no. 4 (October 1, 2013): 61–91. http://dx.doi.org/10.1257/app.5.4.61.

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Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia's Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a “fuzzy” regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally underutilized preventive services—with measurable health gains. (JEL G22, I13, I18, I38, O15)

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Kemper, Peter, Ha T. Tu, James D. Reschovsky, and Elizabeth Schaefer. "Insurance Product Design and its Effects: Trade-offs along the Managed Care Continuum." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 39, no. 2 (May 2002): 101–17. http://dx.doi.org/10.5034/inquiryjrnl_39.2.101.

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This paper uses 1996–97 Community Tracking Study data to analyze the effects of different insurance product designs on service use, access, and consumer assessments of care for nonelderly people with employer-sponsored insurance. Product types are defined by features including use of networks, gatekeeping, capitation, and group/staff model delivery systems. We found no evidence of differences across product types in unmet need or delayed care or use of hospitals, surgery, or emergency rooms. At the same time, different product designs present purchasers with a clear trade-off between paying more out of pocket and encountering more administrative barriers to care. In addition, an increasing proportion of consumers report dissatisfaction with choice of physicians and low trust in physicians as one moves along the managed care continuum from unmanaged to heavily managed products. Our findings have implications for efforts to regulate managed care. The existence of a trade-off between out-of-pocket costs and administrative barriers to care means that some forms of regulation run the risk of reducing choices available to consumers. This is particularly true of regulations that would change the nature of managed care products by prohibiting the use of specific care management tools. To the extent that the backlash against managed care targets restrictions on choice and administrative hassles among consumers who nonetheless choose more heavily managed products because of their lower cost, eliminating heavily managed products would leave those consumers worse off.

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Rodwin, Marc A. "The Metamorphosis of Managed Care: Implications for Health Reform Internationally." Journal of Law, Medicine & Ethics 38, no. 2 (2010): 352–64. http://dx.doi.org/10.1111/j.1748-720x.2010.00494.x.

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Many writers suggest that managed care had a brief life and that we are now in a post-managed care era. Yet managed care has had a long history and continues to thrive. Writers also often assume that managed care is a fixed entity, or focus on its tools, rather than the context in which it operates and the functions it performs. They overlook that managed care has evolved and neglect to examine the role that it plays in the health system.This article argues that private actors and the state have used managed care tools to promote diverse goals. These include the following: increasing access to medical care; restricting physician entrepreneurialism; challenging professional control over the medical economy; curbing medical spending; managing medical practice and markets; furthering the growth of medical markets and private insurance; promoting for-profit medical facilities and insurers; earning bounties for reducing medical expenditures; and reducing governmental responsibility for, and oversight of, medical care. Struggles over these competing goals spurred the metamorphosis of managed care internationally.

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Rie, Michael A. "The Oregonian ICU: Multi-Tiered Monetarized Morality in Health Insurance Law." Journal of Law, Medicine & Ethics 23, no. 2 (1995): 149–66. http://dx.doi.org/10.1111/j.1748-720x.1995.tb01345.x.

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Resource finitude, cost containment, and a purchaser monopsony market have created public concern-about the moral and legal responsibility for quality assurance in health plans. Resource allocation and standards of care represent a clash of moral values in intensive care treatment. This essay advances a procedural model, based on legislation passed in Oregon, that could govern the incorporation of private sector health insurance plans in Oregon to assure democratic input from consumers, providers, and employers into a limited vision of individual entitlement to consume futile or inappropriate care in intensive care units (ICUs). The model, which I call the Oregonian ICU, presumes that rationing of care is implicit and not publicly disclosed under managed care. It focuses on maximizing the quality of limited benefits available in the basic managed care insurance tier. Limitations to futile and inappropriate care are developed on the basis of morally weighted prognostic scoring systems that inform the creation of negotiated private sector contracts.

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30

Mayes, Rick. "Causal Chains and Cost Shifting: How Medicare's Rescue Inadvertently Triggered the Managed-Care Revolution." Journal of Policy History 16, no. 2 (April 2004): 144–74. http://dx.doi.org/10.1353/jph.2004.0010.

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The conventional wisdom on how managed care came to replace traditional fee-for-service reimbursement as the nation's dominant mode of health insurance is that enlightened businesses and their employers led the way in responding to the emergence of market forces in health care in the 1990s. A common textbook treatment of managed care's ascendancy puts it this way: “Transformation of the health care delivery system through managed care has been driven principally by market forces, and reinforced by government.” The irony is that the opposite sequence of events is a more accurate portrayal of what actually happened. As this article shows, the transformation of America's health-care system through managed care was initially triggered—albeit indirectly—by government actions and then driven by market forces. In other words, before business behavior was a cause of managed care's extraordinary growth, it was largely a response to and an unintended consequence of government policymaking: in this instance, Congress's reform of Medicare in 1983.

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31

Dalstrom, Matt, Kim McCullough, and Miaake Slayton. "Unmanaging Managed Care: The Challenges of Privatizing Medicaid in Illinois." Practicing Anthropology 40, no. 3 (June 1, 2018): 45–48. http://dx.doi.org/10.17730/0888-4552.40.3.45.

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Abstract Patients can face significant challenges when government administered Medicaid plans are transitioned to private Medicaid Managed Care (MMC). This is especially true for the homeless population, since transitioning to MMC shifts the responsibility of health insurance coverage to the individual by requiring them to “choose” their health insurance coverage and understand how the plans operate. In Illinois, enrollees are expected to use the state HealthChoice Illinois website to learn about MMC, evaluate their healthcare options, and select a MMC plan. This study provides an anthropological critique of this process. We collected data from focus groups with Medicaid enrollees, interviews with healthcare navigators, and reviews of MMC educational materials from the state of Illinois. Understanding new healthcare challenges that resulted from the transition to MMC will hopefully lead to the development of an improved educational and enrollment process.

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Jensen, Gail A., Michael A. Morrisey, Shannon Gaffney, and Derek K. Liston. "The New Dominance Of Managed Care: Insurance Trends In The 1990s." Health Affairs 16, no. 1 (January 1997): 125–36. http://dx.doi.org/10.1377/hlthaff.16.1.125.

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33

Stafford, Randall S., Stephen M. Davidson, Harriet Davidson, Heidi Miracle-McMahill, Sybil L. Crawford, and David Blumenthal. "Chronic Disease Medication Use in Managed Care and Indemnity Insurance Plans." Health Services Research 38, no. 2 (April 2003): 595–612. http://dx.doi.org/10.1111/1475-6773.00135.

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34

Clancy, Carolyn M., David U. Himmelstein, and Steffie Woolhandler. "Questions and Answers about Managed Competition." International Journal of Health Services 23, no. 2 (April 1993): 213–18. http://dx.doi.org/10.2190/dja5-cgcb-m4rj-3vw9.

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The Managed Competition strategy for health care financing reform would push most people into cut-rate versions of health maintenance organizations chosen for them by their employer and owned by an insurance company. Many of those who currently enjoy good coverage would be forced into bare bones plans, and would forfeit the right to choose their health care provider. There is little evidence that the rigidly multi-tiered system created by Managed Competition would be more efficient or less expensive than the current U.S. system, and administrative costs would likely rise. Promises to expand coverage for the uninsured are likely to fall by the wayside if cost containment fails, and no current Managed Competition proposals address long-term care. In rural areas including at least 30 percent of the U.S. population, price competition central to the Managed Competition strategy is untenable since a lone hospital or other provider cannot compete with itself. Managed Competition would empower vertically integrated corporate health care insurer/providers and disempower patients and the clinical work force.

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Shapiro, Daniel. "Why Even Egalitarians Should Favor Market Health Insurance." Social Philosophy and Policy 15, no. 2 (1998): 84–132. http://dx.doi.org/10.1017/s0265052500001965.

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Socialism is dead, though many of its academic proponents take no notice of its demise. With its death, private property in the means of production is not generally in dispute, and the action in political philosophy centers on the justification of the welfare state. The heart of the welfare state is social insurance programs, such as government managed and subsidized health insurance, retirement pensions, and unemployment insurance. The arguments about health insurance will arguably be among the most ferocious, difficult, and important of the welfare-state debates: Ferocious, because proposals to alter government managed or subsidized health care strike at people's fears and concerns in a way matched by few other proposals. Difficult, because people can often not even conceive of a (genuine) market alternative to the status quo in health insurance, and there is no real existing alternative to hold up as a model. Important, because if an intellectually solid case for market health insurance can be established, then supporters of the welfare state should be on the defensive, since social health insurance is an institution central to their vision of the just or good society.

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Dorros, Torin A., and T. Howard Stone. "Implications of Negligent Selection and Retention of Physicians in the Age of ERISA." American Journal of Law & Medicine 21, no. 4 (1995): 383–418. http://dx.doi.org/10.1017/s0098858800007498.

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Enormous and fundamental changes are currently taking place in health care delivery. These changes include the consolidation of health care providers—from hospitals, physicians, and insurance companies, to medical supply businesses, managed care networks, and other health care providers—and numerous health care and insurance reform efforts by government at all levels. These changes pose significant implications for the delivery of health care in the United States, and will impact the manner, cost, and accessibility of health care delivery. These changes will almost certainly affect the quality of health care services as well. The quality of health care in the United States has for many years been a central concern of government, industry, health care providers, payors, and consumers. Quality in health care is essential to overall national health, the guarantor of a productive and healthy populace, and an important indicator of United States social and technological preeminence.

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Gibbs, Reginald L., John M. Dodd, Anton Hecimovic, and Elia Nickoloff. "Managed Care Administrators' Opinion of Vocational Reahbilitation Services." Journal of Applied Rehabilitation Counseling 27, no. 1 (March 1, 1996): 42–44. http://dx.doi.org/10.1891/0047-2220.27.1.42.

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Rising health care insurance premiums have forced many businesses and institutions to examine cost-cutting measures to lower health care costs. Managed care is one measure that has become widespread throughout the United States. The problem was to learn how managed care administrators view the role and purpose of vocational rehabilitation services in their organizations and if these services will lower short-term and long-term use. A survey was sent to the administrators of fifty managed care organizations in the states of Arizona, Colorado, Oregon, and Washington. Twenty of the fifty administrators responded to the survey. Results show that only one of the managed care organizations offered vocational rehabilitation services to their enrollees. The results also show that three responded that short-term use and ten responded that long-term use of managed care programs would be reduced if vocational rehabilitation services were offered.

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Bardey, David, and Giancarlo Buitrago. "Supplemental health insurance in the Colombian managed care system: Adverse or advantageous selection?" Journal of Health Economics 56 (December 2017): 317–29. http://dx.doi.org/10.1016/j.jhealeco.2017.02.008.

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39

Ikeda, Shunya. "The Health Insurance System in the United States : DRG/PPS and Managed Care." Japanese Journal of Neurosurgery 12, no. 2 (2003): 75–80. http://dx.doi.org/10.7887/jcns.12.75.

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40

Gabel, Jon, Larry Levitt, Jeremy Pickreign, Heidi Whitmore, Erin Holve, Diane Rowland, Kelley Dhont, and Samantha Hawkins. "Job-Based Health Insurance In 2001: Inflation Hits Double Digits, Managed Care Retreats." Health Affairs 20, no. 5 (September 2001): 180–86. http://dx.doi.org/10.1377/hlthaff.20.5.180.

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41

Marton, James, and Aaron Yelowitz. "Health insurance generosity and conditional coverage: Evidence from medicaid managed care in Kentucky." Southern Economic Journal 82, no. 2 (March 23, 2015): 535–55. http://dx.doi.org/10.1002/soej.12064.

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42

Robinson, James C. "From Managed Care To Consumer Health Insurance: The Fall And Rise Of Aetna." Health Affairs 23, no. 2 (March 2004): 43–55. http://dx.doi.org/10.1377/hlthaff.23.2.43.

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43

Menger, Richard P., Jai Deep Thakur, Gary Jain, and Anil Nanda. "Impact of insurance precertification on neurosurgery practice and health care delivery." Journal of Neurosurgery 127, no. 2 (August 2017): 332–37. http://dx.doi.org/10.3171/2016.5.jns152135.

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OBJECTIVEInsurance preauthorization is used as a third-party tool to reduce health care costs. Given the expansion of managed care, the impact of the insurance preauthorization process in delaying health care delivery warrants investigation through a diversified neurosurgery practice.METHODSData for 1985 patients were prospectively gathered over a 12-month period from July 1, 2014, until June 30, 2015. Information regarding attending, procedure, procedure type, insurance type, need for insurance approval, number of days for authorization, or insurance denial was obtained. Delay in authorization was defined as any wait period greater than 7 days. Some of the parameters were added retrospectively to enhance this study; hence, the total number of subjects may vary for different variables.RESULTSThe most common procedure was back surgery with instrumentation (28%). Most of the patients had commercial insurance (57%) while Medicaid was the least common (1%). Across all neurosurgery procedures, insurance authorization, on average, was delayed 9 days with commercial insurance, 10.7 days with Tricare insurance, 8.5 days with Medicare insurance, 11.5 days with Medicaid, and 14.4 days with workers' compensation. Two percent of all patients were denied insurance preauthorization without any statistical trend or association. Of the 1985 patients, 1045 (52.6%) patients had instrumentation procedures. Independent of insurance type, instrumentation procedures were more likely to have delays in authorization (p = 0.001). Independent of procedure type, patients with Tricare (military) insurance were more likely to have a delay in approval for surgery (p = 0.02). Predictably, Medicare insurance was protective against a delay in surgery (p = 0.001).CONCLUSIONSChoice of insurance provider and instrumentation procedures were independent risk factors for a delay in insurance preauthorization. Neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data to deliver the best and most efficient care to our patients.

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Richards, Michael R., and D. Sebastian Tello-Trillo. "Public Spillovers from Private Insurance Contracting: Physician Responses to Managed Care." American Economic Journal: Economic Policy 11, no. 4 (November 1, 2019): 375–403. http://dx.doi.org/10.1257/pol.20170441.

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Managed care is rebounding as more emphasis is placed on cost containment. These efforts may benefit consumers but challenge providers; however, empirical evidence on how supply-side managed care influences physicians is incomplete. We leverage a quasi-experiment3 in which a commercial insurer imposed a new contract regime on behavioral health providers in response to recent policy shifts. We demonstrate spillovers in the form of negative effects on local physician supply and positive effects on Medicare and Medicaid participation in areas where the insurer has market power. Commercially insured patients are also not obviously harmed but receive less intense services in some settings. (JEL G22, I11, I13, I18, I38, J22, J44)

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Woolhandler, Steffie, and David U. Himmelstein. "Clinton's Health Plan: Prudential's Choice." International Journal of Health Services 24, no. 4 (October 1994): 583–92. http://dx.doi.org/10.2190/qgaf-7lu5-fk81-j6a8.

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President Clinton has proposed a managed competition model for health care reform. This strategy would accelerate the corporatization of U.S. health care resulting in more bureaucracy, less patient choice, and a health system owned by a few insurance giants. There is no evidence that competition or other central features of Clinton's plan can lower costs or improve quality. Because cost containment is doubtful, the promised expansion of coverage is unlikely to be implemented.

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Sugerman, Susan, Neal Halfon, Arleen Fink, Martin Anderson, Laurie Valle, and Robert H. Brook. "Family planning clinic patients: their usual health care providers, insurance status, and implications for managed care." Journal of Adolescent Health 27, no. 1 (July 2000): 25–33. http://dx.doi.org/10.1016/s1054-139x(99)00126-3.

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Gostin, Larry O. (Larry Ogalthorpe). "Personal Privacy in the Health Care System: Employer-Sponsored Insurance, Managed Care, and Integrated Delivery Systems." Kennedy Institute of Ethics Journal 7, no. 4 (1997): 361–76. http://dx.doi.org/10.1353/ken.1997.0033.

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Zweifel, Peter, and Michael Breuer. "The case for risk-based premiums in public health insurance." Health Economics, Policy and Law 1, no. 2 (March 23, 2006): 171–88. http://dx.doi.org/10.1017/s1744133105001064.

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Uniform, risk-independent insurance premiums are accepted as part of ‘managed competition’ in health care. However, they are not compatible with optimality of health insurance contracts in the presence of both ex ante and ex post moral hazard. They have adverse effects on insurer behaviour even if risk adjustment is taken into account. Risk-based premiums combined with means-tested, tax-financed transfers are advocated as an alternative.

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Sing, Merrile, and Beth Stevens. "The Value of Experience: Differences in Knowledge among Medicare Beneficiaries." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 42, no. 3 (August 2005): 266–80. http://dx.doi.org/10.5034/inquiryjrnl_42.3.266.

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The Medicare Advantage program gives Medicare beneficiaries the opportunity to choose from an array of insurance options instead of receiving prescribed benefits. In 2006, beneficiaries who want prescription drug benefits will need to enroll in a Medicare managed care plan or a private prescription drug plan. To examine awareness and use of Medicare information programs, and the extent to which these programs are associated with beneficiary knowledge about Medicare and managed care, we conducted a national survey of Medicare beneficiaries six to 12 months after the nationwide mailing of the Medicare & You 2000 handbook. Beneficiary information-gathering behavior and experience with Medicare managed care were more highly associated with knowledge about Medicare managed care than formal education, age, income, or membership in a managed care plan before enrolling in Medicare. Practical life experience appears to outweigh traditional factors in beneficiary knowledge of Medicare and managed care.

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Unger, Jean-Pierre, and Pierre De Paepe. "Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency?" International Journal of Health Services 49, no. 3 (May 8, 2019): 431–56. http://dx.doi.org/10.1177/0020731419847113.

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This article evaluates the performance of 3 industrialized nations that have pursued market-based financing models, focusing on equity in access to care, care quality, health status, and efficiency. It then assesses the consistency of the findings with those of different research teams. Using secondary data obtained from a semi-structured review of articles from 2000 to 2017, we discuss the hypothesis that commercial health care insurance is detrimental to accessing professional health care and to population health status. The results show that in 2010 the unmet care needs of both poor and rich Americans exceeded those of the poor in several industrial countries. The number of Dutch adults experiencing financial obstacles to health care quadrupled between 2007 and 2013, and 22% of Swiss adults reported skipping needed care in a 2016 survey. The most negative impacts of “managed care” on care quality are its tight constraints on physicians’ professional autonomy; a large reliance on the physicians’ material motivation; health service fragmentation; and the tendency to apply evidence-based medicine too rigidly. Countries with a commercial insurance monopoly generally remained above the maternal, infant, and neonatal mortality rates versus the health-spending regression line. We conclude that the most inefficient system is where the insurance market has achieved its maximal development and that care industrialization contributes to the comparatively poor performance of the U.S., Dutch, and Swiss health systems.

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Journal articles on the topic 'Managed care health insurance'

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