managed health care


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managed health care,

system of health-care delivery that aims to control costs by assigning set fees for services, monitoring the need for procedures such as tests and surgical operations, and stressing preventive care. Managed health-care systems include health maintenance organizationshealth maintenance organization
(HMO), type of prepaid medical service in which members pay a monthly or yearly fee for all health care, including hospitalization. The term "health maintenance organization" was coined by a health policy analyst, Dr.
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; preferred provider organizations (PPOs), networks of doctors and hospitals that adhere to given guidelines and fees in return for receiving a certain number of patients; and point of service (POS) plans, which are similar to PPOs but allow patients to go outside the network for treatment, usually at a higher cost. The term is also used to describe more traditional health-insurance plans that require that more expensive procedures be reviewed and approved by a plan official before they are performed. In managed care, the doctor is often paid a set fee or is paid a set amount monthly for each patient, a scheme called capitation. Many physicians criticize managed care systems, saying that they take away their freedom to make treatment decisions, that they are motivated mainly by economics, and that they do not consider patients as individuals. Managed health-care systems also limit doctors' incomes and what many people consider to be the abuses of the older fee-for-service system that rewarded doctors financially for doing more procedures. See also health insurancehealth insurance,
prepayment plan providing services or cash indemnities for medical care needed in times of illness or disability. It is effected by voluntary plans, either commercial or nonprofit, or by compulsory national insurance plans, usually connected with a social
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References in periodicals archive ?
On May 25, the company announced that its California managed health care subsidiary filed for Chapter 11 bankruptcy protection.
To answer that question, Aetna Life and Casualty, in coordination with The Hastings Center, a private, nonprofit, nonpartisan medical ethics "think tank," is conducting a one- year study of ethical issues surrounding the management and delivery of health care by managed health care companies.
California has been a nationwide leader in managed health care, helping businesses lower their health care costs while providing health care access to millions of consumers.
We are pleased at being selected by the State of Georgia, and intend to continue our focus on being the industry leader in providing quality, cost-effective managed health care services," Dr.
By continuing utilization review, case management and other specialized services to PRS's customers, CAPP CARE will continue the tradition of providing unique customer service and demonstrated value through its managed health care services.
To that end, the Chamber's Managed Health Care Committee developed selection criteria and coordinated the selection process.
is among the nation's largest publicly traded managed health care companies and the nation's fourth-largest Medicare Advantage contractor, based on membership.
CHOICE Administrators[R] today announced that First Dental Health, the provider organization for its discount dental plans offered at no additional cost to employers who are not currently offering dental coverage, has been awarded the state's first license for a discount dental plan under a new regulatory program established by the California Department of Managed Health Care (DMHC).
The California Department of Managed Health Care (DMHC) has regulatory authority over the discount health care industry, enforcing the nation's most stringent and consumer-friendly licensing requirements.

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