Global theory and the nature of risk, Part 2. Towards a choice-based model of managed care.
Orthodox managed care depends on top-down, command and control techniques to squeeze efficiency out of the system. But for every unit of economic good this approach produces, two or three bad units come as result. The key to moving to an environment where value and efficiency become self-sustaining is to structurally recognize the medicoeconomic reality of medicine: the episode of care. The episode forms a natural unit of analysis that not only renders costs and outcomes information translucent and accessible, but it also forms the natural conduit through which premium dollars can find their optimal value. By bifurcating probability risk from technical risk and allocating them in the ex ante and ex post markets, respectively, health care insurers and providers return to their rightful economic roles, and to their appropriate fiduciary duties. And patients regain some semblance of reasonable sovereignty in managing their own medical affairs.
Emery
D W
DW
Institute of Political Economy, Utah State University, USA. m@burgoyne.com
D003258:Consumer Behavior; D017050:Episode of Care; D005249:Fees and Charges; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D017146:Models, Organizational; D011209:Power, Psychological; D011357:Product Line Management; D014481:United States