Related Experiment Video
Updated: Aug 4, 2026
14:32
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Evaluating the quality control system for managed care in the United States
1Kenan-Flagler Business School, School of Public Health, University of North Carolina, Chapel Hill, USA.
Quality Management in Health Care
|May 27, 1999
Summary
The US managed care system, while unique, is robust. This review highlights quality assessment tools for providers, patients, and insurers, recommending the Donabedian Matrix for contract evaluation.
Area of Science:
- Healthcare Management
- Quality Improvement
- Health Policy
Background:
- The United States healthcare system features a complex managed care environment.
- Ensuring consistent quality of care within this system presents ongoing challenges for stakeholders.
Purpose of the Study:
- To review existing mechanisms for assessing the quality of care in US managed care.
- To provide guidance on evaluating managed care contracts effectively.
Main Methods:
- Literature review of quality assessment tools and frameworks.
- Analysis of stakeholder roles (providers, patients, insurers, government) in quality control.
- Introduction of the Donabedian Matrix as an evaluative tool.
Main Results:
- The US managed care system possesses robust, albeit idiosyncratic, quality control mechanisms.
- Various tools are available for providers, patients, insurers, and governments to monitor care quality.
- The Donabedian Matrix offers a structured approach to identifying strengths and weaknesses in managed care contracts.
Conclusions:
- Healthcare providers, patients, and insurers can leverage existing mechanisms to assess and ensure quality of care.
- Contracting entities should utilize frameworks like the Donabedian Matrix to strengthen managed care agreements.
- Effective contract evaluation is crucial for maintaining and improving healthcare quality within managed care systems.
Related Concept Videos
01:18Introduction To Health Care Delivery System
The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:26Methods Of Healthcare Delivery System
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:15Methods of Documentation VI: Case Management Model
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
For example, a patient with a chronic illness...
01:30Health Information Technology and Healthcare Information System
Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:05Quality Control
Quality control is one of the three cyclical quality assurance activities that help keep a system under statistical control. Typical quality control activities include creating quality control charts, conducting proficiency testing, and documenting and archiving results.
Quality control helps track data, visualize trends, and identify variations, making it easier to detect deviations that may affect the accuracy of an analysis. One way to do this is by generating a quality control chart, which...
Quality control helps track data, visualize trends, and identify variations, making it easier to detect deviations that may affect the accuracy of an analysis. One way to do this is by generating a quality control chart, which...
01:19Quality Assurance
Quality assurance is the overarching term used to describe the activities employed to ensure the proper performance of a system. These activities can be classified into three categories: quality control, quality assessment, and internal corrective measures. Typically, these activities work cyclically: quality control is performed before and during the analysis, while quality assessment occurs during and after the investigation. Internal corrective measures are implemented based on the findings...