title: Understanding the World of Managed Care: Opportunities and Obstacles for Rehabilitation Teams.
abstract: Rehabilitation services were not included in the early drive to reduce costs by prospective payment to hospitals for diagnostic related groups (DRGs) of disease or condition. The idea that a hospital could restrict some services and realize a profit on the prospective fee or be sadly underpaid if a patient stay was particularly costly was new in the 1970s. This early form of managed care was designed to curb skyrocketing health care costs. It was not until the late 1980s that managed care for elderly and disabled persons through some Medicare expenditure experiments came about. Still, rehabilitation services were not included. Stroke survivors receive a large portion of their care in rehabilitation services, both in institutions and in the community. This article presents a simple view of managed care, its opportunities and obstacles, with special reference to the impact it can have on the care of stroke survivors in the future. The end purpose is to engage rehabilitation providers in a needed advocacy for the development of sound managed care practices for stroke survivors.
authors.forename: K B
authors.initials: KB
authors.lastname: Abramson
keywords: health maintenance organizations (HMOs); managed care; managed care organizations (MCOs); point of service (POS) products; preferred provider organizations (PPOs); rehabilitation providers