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Managed care in the United States
F D Scutchfield1, J Lee, D Patton
1Center for Health Services Research, Policy and Management, University of Kentucky Medical Center, Lexington 40536-0003, USA.
Journal of Public Health Medicine
|November 5, 1997
Summary
Managed care, including Health Maintenance Organizations (HMOs), offers cost control in US healthcare through financial risk-sharing. While enrollment is rising, it may not be the ultimate solution for healthcare provision.
Area of Science:
- Health Economics
- Healthcare Management
Background:
- US healthcare spending is rising as a percentage of GDP.
- Managed care models are increasingly adopted to control costs.
- Various managed care types exist, including PPOs, EPOs, and HMOs.
Purpose of the Study:
- To examine the role and mechanisms of managed care in controlling healthcare costs.
- To understand the different risk-sharing strategies employed in managed care.
- To assess the impact of managed care on service delivery and future healthcare trends.
Main Methods:
- Analysis of managed care financing and delivery mechanisms.
- Description of risk-control strategies: capitation, risk pools, and withholds.
- Review of service utilization patterns, including same-day surgery and outpatient treatment.
Main Results:
- Health Maintenance Organizations (HMOs) utilize prepaid premiums and provider financial risk.
- Capitation, risk pools, and withholds are key methods for managing costs and behavior.
- HMOs have driven innovations like same-day surgery and outpatient care, reducing hospital stays.
Conclusions:
- Managed care, particularly HMOs, is a significant trend for controlling US healthcare expenditures.
- Government programs like Medicare and Medicaid are increasingly offering managed care options.
- Despite its growth, managed care is not presented as a definitive, final solution for US healthcare challenges.