Continuity of Care, Informed Consent, and Fiduciary Responsibilities in For-Profit Managed Care Systems

2000 ◽  
Vol 9 (1) ◽  
pp. 21-25
Author(s):  
W. L. Holleman
Keyword(s):  
Informed Consent ◽  
Managed Care ◽  
Continuity Of Care ◽  
For Profit ◽  
Care Systems

Managed care and informed consent

2008 ◽  
Author(s):  
Lara Austan ◽  
Jeffrey E. Barnett
Keyword(s):  
Informed Consent ◽  
Managed Care

Comments of a Reactor Panel

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1289-1292 ◽  
Author(s):  
Michael Applebaum
Keyword(s):  
Managed Care ◽  
Strategic Alliances ◽  
Community Setting ◽  
Care Plan ◽  
Personal Perspective ◽  
Kaiser Permanente ◽  
Pediatric Residency ◽  
Care Systems ◽  
Teaching Faculty ◽  
Teaching Programs

First, let me just say that managed care means different things to different people. I want to give you my personal perspective on pediatric residency training in community settings based on my own experiences in a nonprofit, physician-directed managed care system, Kaiser Permanente Health Care Plan, that has a 50-year history. My experience is, therefore, probably somewhat unusual and different from that of many other physicians throughout the country. As I wandered back and forth among the various workshops during this conference, managed care was a prominent theme in most. I am going to restrict my comments to three areas: recruitment, evaluation, and financing. With regard to recruitment, managed care systems are likely to have a strong interest in developing strategic alliances with academic teaching centers, but this interest is based on a reciprocity of needs. These kinds of alliances can only flourish when there is mutual trust that emerges after a variety of discussions at several levels. Managed care systems can be encouraged, then, to participate actively in teaching programs, and they may be significant sources for recruiting teaching faculty. Some managed care systems can provide stable, multicultural patient populations that are derived from the communities in which they practice. Continuity experiences provided to residents focus on health and prevention issues as opposed to disease orientation. Managed care systems can be rich resources for population research in which residents can participate. Another issue has not been raised here to any major extent, as far as I know. Teaching residents in a community setting can also involve inpatient care in a community hospital.

Paradoxical effects of cost reduction measures in managed care systems for treatment of severe psoriasis

2009 ◽  
Vol 15 (4) ◽  
Author(s):  
Brad A Yentzer ◽  
Christopher B Yelverton ◽  
Gregory L Simpson ◽  
Jason F Simpson ◽  
Wenke Hwang ◽  
...  
Keyword(s):  
Managed Care ◽  
Cost Reduction ◽  
Severe Psoriasis ◽  
Paradoxical Effects ◽  
Care Systems

Managed Care and Informed Consent

2001 ◽  
Author(s):  
Jessica W. Berg ◽  
Paul S. Appelbaum ◽  
Charles W. Lidz ◽  
Lisa S. Parker
Keyword(s):  
World War Ii ◽  
Informed Consent ◽  
Managed Care ◽  
Cost Of Care ◽  
Medical Illness ◽  
Care Organization ◽  
Ethical Perspective ◽  
Economic Framework ◽  
Practice Of Medicine ◽  
American Medicine

In the last decade, American medicine has been transformed by a series of changes in the economic arrangements governing clinical practice that have come to be known genetically as “managed care.” Since the nature of these changes is complex and the process of evolution incomplete, managed care evades efforts at easy definition. However, it is probably fair to say, as Iglehart has, that “[a]ll forms of managed care represent attempts to control costs by modifying the behavior of doctors, although they do so in different ways”. Managed care’s alteration of some of the basic premises of the physicianpatient relationship, has raised serious questions about its effect on the doctrine of informed consent. To take but one example, if the physician is now subject to incentives from a managed care organization to decrease the amount and cost of care provided, would this information be material to the decision making of a reasonable patient? Should the law therefore require that such information be disclosed? If so, who should disclose this information, and when should the disclosure be made? At this stage, most of the questions that can be framed are, like this one, not susceptible to definitive answers from a legal or ethical perspective. But the potential impact of these new means of authorizing and paying for medical treatment is so substantial that there is value in laying out the issues to which jurists and legislators will have to respond, and in providing some initial guidance to clinicians and administrators. These are the goals of this chapter. To understand the changes wrought by managed care in the practice of medicine— and their possible relevance for informed consent law—one needs to begin by recalling the economic framework of medical care during the development of the doctrine of informed consent. With the growth of employer-provided health insurance following World War II, most middle-class Americans and their families were freed of the spectre of bankruptcy attending serious medical illness (2).

scholarly journals Older multimorbid patients’ experiences on integration of services: a systematic review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lilian Keene Boye ◽  
Christian Backer Mogensen ◽  
Tine Mechlenborg ◽  
Frans Boch Waldorff ◽  
Pernille Tanggaard Andersen
Keyword(s):  
Health Care ◽  
Continuity Of Care ◽  
Health Care Services ◽  
Health Care Systems ◽  
Easy Access ◽  
Ageing Population ◽  
Health Providers ◽  
Care Coordinator ◽  
Care Services ◽  
Care Systems

Abstract Background Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. Methods A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. Inclusion criteria: studies exploring patients’ point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. Results Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. Conclusions Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.

Options Analysis of Managed Care Contracting and Regulation: Theory and Evidence

2000 ◽  
Vol 13 (3) ◽  
pp. 170-177
Author(s):  
R. A. McLean ◽  
F. T. Magiera
Keyword(s):  
Managed Care ◽  
Call Option ◽  
Put Options ◽  
Net Worth ◽  
Regulatory Issues ◽  
For Profit ◽  
Care Plans ◽  
Using Data ◽  
Managed Care Organizations ◽  
Options Theory

Managed care contracts can be represented as bundles of options. In particular, the managed care provider is short a call option. To hedge the risk involved in such contracts, managed care contractors can construct several types of virtual put options, among them the ownership of facilities. Agency theory and options theory suggest that for-profit managed care plans, in the presence of debt, will engage in less hedging activity than will other managed care plans. Here, the authors test that hypothesis, using data for Florida HMOs in 1995, and they reject the null hypothesis. That managed care organizations act as if they are short a call option raises interesting regulatory issues, including the possibility of using a hedge-based regulatory scheme in place of a net-worth-based scheme.

Does Health Status Matter? Examining the Experiences of the Chronically Ill in Medicaid Managed Care

2002 ◽  
Vol 21 (1) ◽  
pp. 53-65 ◽  
Author(s):  
Marlys J. Mason ◽  
Debra L. Scammon ◽  
Robert P. Huefner
Keyword(s):  
Public Policy ◽  
Health Status ◽  
Managed Care ◽  
General Population ◽  
Special Needs ◽  
Continuity Of Care ◽  
Cost Efficiency ◽  
Chronically Ill ◽  
Medicaid Managed Care ◽  
Policy Initiatives

Managed care's promises of improved cost efficiency and continuity of care to the general population are being tested by the higher demands of Medicare and Medicaid populations, including many chronically ill individuals. By examining and comparing satisfaction among chronically ill and healthier enrollees and between Medicaid and non-Medicaid enrollees, the authors develop an understanding of how satisfaction among the chronically ill provides assessments that are important to all enrollees. The authors examine public policy initiatives in the context of the special needs of the chronically ill to determine whether the initiatives are likely to help generate improvements with respect to aspects of care and access that are most important to the chronically ill and ultimately to enrollees in general.

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