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 ?
This has been mandated by the external accountability effects of increasing public scrutiny, economic pressures on employers, governmental regulations, third party insurance payers, and managed health care. Validity analysis and appropriateness evaluation of these tools as applied to health care delivery is at best in its infancy.
An overview session will be held that day, providing data on the status of pharmacy benefits management firms, managed health care and the pharmaceutical industry.
Anthony Dolan has been appointed director of managed health care. In his new position he will oversee mail-order and nursing home pharmacy for the drug chain.
It serves a number of niche markets such as long-term care pharmacies, assisted living facilities, long-term care facilities, infusion and speciality pharmacies.Country: USASector: Healthcare, Business and Consumer ServicesTarget: Managed Health Care Associates IncBuyer: Roper Industries IncDeal size in USD: 1bnType: Corporate acquisitionFinancing: Cash & Debt, Existing resourcesStatus: Closed
The study, Managed Health Care: A Benefit and a Burden for Pharmacy, was based on personal interviews with 500 pharmacists throughout the country.
Roper manufactures engineered products and solutions for global niche markets, such as software information networks, medical, water, energy and transportation.Country: USASector: Business and Consumer Services, HealthcareTarget: Managed Health Care Associates Inc Buyer: Roper Industries IncDeal size in USD: 1bnType: Corporate acquisitionStatus: Agreed
Today, with 72% of chain drug pharmacies reporting affiliations with managed health care organizations, the study indicates that the problem is, if anything even more vexing.
M2 EQUITYBITES-July 8, 2015-Canadian Claims Management Company Global Excel Acquires Olympus Managed Health Care
For many reasons, the impact of psychosocial factors and physician-patient relationships on the nature of health care as described in traditional systems may be even more critical in managed health care. In fact, many of the influences already described have been extensively examined in managed care environments.
Health Net Federal Services is a wholly owned subsidiary of Health Net (NYSE:HNT), which delivers managed health care services through health plans and government-sponsored managed care plans.
* Many of the ideas for this article were gleaned from Peter Kongsvedt's excellent book The Managed Health Care Handbook, Second Edition, Gaithersburg, Md.: Aspen Publications, 1993.
She is a member of College's Societies on Federal, State, and Local Government and on Managed Health Care Organizations and of its Forum on Women in Medicine and Management

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