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Related Experiment Videos

Joining forces to make managed health care work.

P Boland

    Healthcare Financial Management : Journal of the Healthcare Financial Management Association
    |November 5, 1990
    PubMed
    Summary

    Managed healthcare requires revised rules for equitable risk and gain sharing among all parties. Rewriting these structures can make health plans more effective and cost-efficient for the healthcare system.

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    Area of Science:

    • Healthcare Management
    • Health Economics
    • Policy Analysis

    Background:

    • Managed care has historically struggled to achieve cost-effectiveness in the U.S. healthcare system.
    • Existing healthcare plans face challenges in equitable distribution of financial risks and rewards.
    • Key stakeholders in healthcare include providers, payers, and consumers.

    Purpose of the Study:

    • To analyze the foundational principles of managed care.
    • To evaluate the successes and failures of managed care implementation.
    • To propose strategies for improving the efficacy of structured health plans.

    Main Methods:

    • Review of managed care literature and industry trends.
    • Analysis of stakeholder perspectives (providers, payers, consumers).
    • Examination of risk-sharing and gain-sharing models.

    Main Results:

    • Managed care has not consistently delivered cost-effectiveness as intended.
    • Equitable distribution of financial risks and rewards is crucial for success.
    • Revising the rules of engagement can improve healthcare plan functionality.

    Conclusions:

    • Structured health plans can be effective with appropriate rule modifications.
    • Fairer risk-sharing and gain-sharing models are essential for a functional managed care system.
    • Future trends in managed care will significantly impact the overall healthcare industry.

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