Related Experiment Videos
Regulating managed care firms: the Connecticut plan
1Center for Health Systems Management, University of Connecticut.
Benefits Quarterly
|December 10, 1991
Summary
State governments nationwide are considering legislation to regulate managed care companies. A Connecticut study examined regulatory approaches for utilization review, offering recommendations for effective oversight.
Area of Science:
- Health Policy
- Healthcare Management
- Regulatory Affairs
Background:
- Increasing legislative interest in regulating utilization review (UR) and managed care organizations (MCOs) across the United States.
- Limited research by legislative bodies on the specific forms effective UR/MCO regulation should take.
- Significant growth in UR within managed care programs impacting residents in Connecticut.
Purpose of the Study:
- To analyze the issues surrounding the regulation of utilization review and managed care companies.
- To provide data-driven recommendations for legislative action regarding UR/MCO oversight.
- To inform policymakers on best practices for regulating the managed care industry.
Main Methods:
- Review of existing legislative proposals and regulatory frameworks.
- Analysis of the growth and impact of utilization review in Connecticut.
- Consultation with stakeholders involved in managed care and utilization review.
Main Results:
- Identification of key areas requiring regulatory attention within utilization review processes.
- Development of specific recommendations for legislative bodies considering UR/MCO regulation.
- Assessment of the potential impact of different regulatory models on healthcare access and quality.
Conclusions:
- Effective regulation of utilization review is crucial for ensuring quality healthcare within managed care.
- Connecticut's study offers a model for other states addressing managed care oversight.
- Recommendations focus on balancing regulatory needs with the operational realities of managed care companies.