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Managed care? Not without gatekeepers and capitation.

Health Cost Management

|June 8, 1988

Summary

This summary is machine-generated.

True managed health care requires provider gatekeeping and capitated payments. Employers can shift financial risk to insurers, moving beyond traditional managed care limitations.

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Area of Science:

Health economics and policy
Healthcare management and financing

Background:

Conventional managed care models are often insufficient for achieving true cost control and quality improvement.
The current system frequently places the financial burden of health coverage primarily on employers and employees.

Discussion:

Gatekeeping mechanisms and capitated financial arrangements with healthcare providers are critical components of effective managed health care.
Employers can leverage strategic negotiations to encourage insurance carriers to assume greater financial risk, fostering more equitable partnerships.

Key Insights:

A paradigm shift from shared risk to full risk transfer by insurers is necessary for robust managed care.
The Cigna and Allied-Signal, Inc. arrangement exemplifies a successful model for risk-bearing by insurance carriers.

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Outlook:

This approach can lead to more sustainable and efficient healthcare systems.
Future healthcare models should prioritize provider accountability and innovative financial structures to manage costs and outcomes effectively.