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Ensuring quality and access in managed care: how well are we doing?
1Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, USA.
Quality Management in Health Care
|January 1, 1997
Summary
Proprietary managed care organizations are increasingly handling healthcare tasks. Current quality assurance efforts show concerns regarding incentives, standards, and data systems for these organizations.
Area of Science:
- Health Services Research
- Healthcare Management
- Quality Assurance
Background:
- Proprietary managed care organizations (MCOs) are expanding their role in healthcare delivery through various business strategies.
- These organizations are taking over responsibilities previously managed by government and non-profit healthcare institutions.
Purpose of the Study:
- To examine existing quality assurance initiatives within managed care organizations.
- To identify critical areas of concern within current MCO quality assurance frameworks.
Main Methods:
- Review of current quality assurance practices in proprietary managed care organizations.
- Analysis of identified concerns including incentives, standards, and data systems.
Main Results:
- Managed care organizations face inherent incentives that may lead to substandard service provision.
- There is a notable lack of visible, measurable, and enforceable quality standards for MCOs.
- Existing data and reporting systems are inadequate for generating reliable quality indicators.
Conclusions:
- Current quality assurance mechanisms for managed care organizations are insufficient.
- Addressing issues with incentives, standards, and data systems is crucial for improving MCO quality.
- Further development of robust quality assurance frameworks is needed for proprietary managed care organizations.