Managed Care and Monopoly Power

Managed Care and Monopoly Power
Author: Deborah HAAS-WILSON
Publisher: Harvard University Press
Total Pages: 251
Release: 2009-06-30
Genre: Business & Economics
ISBN: 0674038118

As millions of Americans are aware, health care costs continue to increase rapidly. Much of this increase in health care costs is due to the development of new life-sustaining drugs and procedures, but part of it is due to the increased monopoly power of physicians, insurance companies, and hospitals, as the health care sector undergoes reorganization and consolidation. There are two tools to limit the growth of monopoly power: government regulation and antitrust policy. In this timely book, Deborah Haas-Wilson argues that enforcement of the antitrust laws is the tool of choice in most cases. Focusing on the economic concepts necessary to the enforcement of the antitrust laws in health care markets, Haas-Wilson provides a useful roadmap for guiding the future of these markets.

Health-Care Utilization as a Proxy in Disability Determination

Health-Care Utilization as a Proxy in Disability Determination
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 161
Release: 2018-04-02
Genre: Medical
ISBN: 030946921X

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Improving the Medicare Market

Improving the Medicare Market
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 384
Release: 1996-11-01
Genre: Medical
ISBN: 0309175364

Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.

Managing Managed Care

Managing Managed Care
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 394
Release: 1997-04-21
Genre: Medical
ISBN: 0309175054

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

Handbook of Private Practice

Handbook of Private Practice
Author: Steven Walfish
Publisher: Oxford University Press
Total Pages: 849
Release: 2017
Genre: Medical
ISBN: 0190272163

Handbook of Private Practice is the premier resource for mental health clinicians, covering all aspects of developing and maintaining a successful private practice. Written for graduate students considering the career path of private practice, professionals wanting to transition into private practice, and current private practitioners who want to improve their practice, this book combines the overarching concepts needed to take a mental health practice (whether solo or in a group) from inception, through its lifespan. From envisioning your practice, to accounting and bookkeeping, hiring staff, managing the practice, and running the business of the practice, a diverse group of expert authors describe the practical considerations and steps to take to enhance your success. Chapters cover marketing, dealing with insurance and managed care, and how to choose your advisors. Ethics and risk management are integrated throughout the text with a special section also devoted to these issues and strategies. The last section features 26 niche practices in which expert practitioners describe their special area of practice and discuss important issues and aspects of their specialty practice. These areas include assessment and evaluation, specialized psychotherapy services, working with unique populations of clients, and more. Whether read cover-to-cover or used as a reference to repeatedly come back to when a question or challenge arises, this book is full of practical guidance directly geared to psychologists, counselors, social workers, and marriage and family therapists in independent practice.

Health Care Management and the Law

Health Care Management and the Law
Author: Hammaker
Publisher: Jones & Bartlett Learning
Total Pages: 881
Release: 2017-03-02
Genre: Business & Economics
ISBN: 1284117340

Health Care Management and the Law-2nd Edition is a comprehensive practical health law text relevant to students seeking the basic management skills required to work in health care organizations, as well as students currently working in health care organizations. This text is also relevant to those general health care consumers who are simply attempting to navigate the complex American health care system. Every attempt is made within the text to support health law and management theory with practical applications to current issues.

The Future of Long-Term Care

The Future of Long-Term Care
Author: Pablo Villalobos Dintrans
Publisher: Nova Science Publishers
Total Pages: 0
Release: 2021
Genre: Medical
ISBN: 9781536193961

"Population aging is challenging countries around the globe to adapt their public policy responses to the new world. Long-term care is a relevant topic today both because of the rapid growth in long-term care needs in every country and the lack of responses from governments. The Future of Long-term Care explores some issues related to the implementation of long-term care responses in different countries. Looking at six different cases, the book highlights the need to foster an urgent debate in the area, as well as emphasizing the need for action in the coming years. The examples analyzed show common problems faced by countries trying to respond to their people's needs, as well as the dissimilar stages, contexts, and paths followed by each one in the endeavour for providing long-term care services to the population. Whether the analysis is carried out in countries with well-established long-term care systems or in places where the debate is just starting, the book proves that this is an area in which many challenges remain. Learning lessons from others is important but providing a space for countries to frame their problems and propose their solutions is crucial. This book contributes to fill this gap and contribute to a debate that is just starting in many places around the world"--

Health Insurance and Managed Care

Health Insurance and Managed Care
Author: Peter R. Kongstvedt
Publisher: Jones & Bartlett Learning
Total Pages: 355
Release: 2019-02-14
Genre: Medical
ISBN: 128415209X

Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.