title: On the limits of expanding health care reform: chronic care in prepaid settings.
abstract: Health Maintenance Organizations have become a favored vehicle for reform of the American health care system, while controlling costs and assuring quality. But for populations with a high prevalence of chronic disease--the elderly or the mentally ill--HMOs may fall short of meeting needs. Three stages of reform are proposed for adapting the principle of prepayment to better serve enrollees with chronic illness.
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D003365:Costs and Cost Analysis; D005251:Fees, Medical; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007326:Institutionalization / Q000191:economics / Q000639:trends; D008134:Long-Term Care / Q000191:economics; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D001523:Mental Disorders / Q000191:economics / Q000628:therapy; D011050:Policy Making; D014481:United States