Managing costs and managing care.
With a defined population served, contracted provider panels and the nature of care delivery integration, managed care has provided a solution, though not a panacea, to provide equitable services, standardized and prevention oriented cares to its enrolled members. Combined with the earmarked capitation reimbursement system and a series of cost containment and utilization review techniques, managed care has also demonstrated potently its capacity in cost-saving and quality promotion. Presents steps and measures related to managed care that federal government has taken to manage care and contain cost. It is crucial to identify and promulgate best practices continually, while managing utilization of resources for improving health care, containing cost, and equalizing medical care access to a greater proportion of the population. Concludes that it may take time for a universal adoption of managed care. However, Americans may actually benefit more from having a standard level of health care that managed care could achieve and provide.
Rivers
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Graduate School of Health Administration and Policy, College of Business, Arizona State University, Tempe, Arizona, USA.
Tsai
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D003363:Cost Control / Q000379:methods; D003659:Decision Making, Organizational; D019468:Disease Management; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D017749:Total Quality Management / Q000379:methods*; D014481:United States; D014600:Utilization Review