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Four primary hospital-physician models are per-click service agreements, management services agreements, gainsharing, and equity joint ventures. Four key attributes needed for successful joint ventures are clinical quality, customer satisfaction, operational effectiveness, and financial soundness. Hospitals and physicians need to approach joint ventures with expectations of high performance.
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Theoretical bases of creation, stages of development, normative-and-legal base, structure and problems of a All-Russia service of disaster medicine are stated. In article some questions about experience of rendering of the medical aid to the injured in the extreme situations (North Caucus region, Sakhalin, Budenovsk, Irkutsk), training of personnel, creation of reserves of medical property for extreme situations, organization of service management are submitted. The federal program "Perfection of All-Russia service of disaster medicine on 1997-2001 years" is considered in detail.
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Based on a survey of community health service organization in several cities, community health service model based on the family clinic was compared with state-owned community health service model, and status quo, advantages and problems of family community health service organization were analyzed. Furthermore, policies for the management of community health service organization based on the family clinic were put forward.
OBJECTIVE: To study the ways in which allocating the risk for behavioral health care expenses between employers and a managed behavioral health organization affects costs and the use of services. DATA SOURCES: Claims from 87 plans that cover mental health and substance abuse services covering over one million member years in 1996/1997. STUDY DESIGN: Multi-part regression models for health care cost are used. Dependent variables are health care costs decomposed into access to any care, costs per user, any inpatient use, costs per outpatient user, and costs per inpatient user. The study compares full-risk plans, in which the managed care organization provides managed care services and acts as the insurer by assuming the risk for claims costs, with contracts in which the managed care organization only manages care (for a fixed administrative fee) and the employer retains the risk for claims. PRINCIPAL FINDINGS: Full-risk plans are not statistically significantly different from non-risk plans in terms of any mental health specialty use or hospitalization rates, but costs per user are significantly lower, in particular for inpatients. CONCLUSIONS: Risk contracts do not affect initial access to mental health specialty care or hospitalization rates, but patients in risk contracts have lower costs, either because of lower intensity of care or because they are treated by less expensive providers.
Service provision and client utilization at the catchment area level were studied to provide data relevant to (a) comprehensiveness of care, (b) client behavior with human service organizations, and (c) management and policy in times of fiscal decline and/or scarcity. Four human service organizations and 3529 clients seen over a six-month period were sampled. At the system level, data revealed a 100% duplication rate by the four organizations for nine service categories. At the individual level, 7% (n = 250) of the clients were multiorganization users and of these, only 150 received duplicated services. Implications of these data for comprehensiveness of care, utilization and provision duplication, human service system impetus and future research were discussed. Overcomprehensiveness of service provision may be a problem. At the client level, more research on differences between the multiorganization user who does and does not receive duplicated services is needed.
This article describes the integrated case management model being developed by AID Atlanta, Inc., a community-based AIDS service organization. The case management system features centralized supervision and coordination with decentralized delivery of case management services that avoid duplication of services. The model establishes a system that links clients to appropriate levels of service. The integrated model seeks to address the client's physical, psychological, emotional, and spiritual needs across a continuum of care delivery. The cornerstone of the system is the development of standards of service, systematic documentation, and outcome evaluation criteria.
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An academic department of psychiatry in New York City eliminated the need for behavioral managed care intermediaries by transforming itself from a fee-for-service system to a system able to engage in full-risk capitation contracts. The first step was to require health maintenance organizations to contract directly with the department. The department formed two legal entities, a behavioral management services organization for utilization management and a behavioral integrated provider association. The authors describe these entities and review the first year of operation, presenting data on enrollees, capitation rates, and service utilization for the first three contracts. The fundamental differences in the treatment model under managed care and under a fee-for-service system are highlighted. The authors conclude that by contracting directly with insurers on a full-risk capitation basis, departments of psychiatry will be better able to face the economic threats posed by the cost constraints inherent in managed care and maintain or re-establish their autonomy as care managers as well as high-quality care providers.
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Health and social service organizations in the United States are experiencing decline in financial resources. Little is known about the management of such decline. Forty-three executives of health and human service organizations were interviewed to study their experience with cutback management. The political strategies used by the executives to cope with cutbacks are described.
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This article illustrates how management in one type of service industry, the health maintenance organization (HMO), have attempted to formalize pricing. This effort is complicated by both the intangibility of the service delivered and the relatively greater influence in service industries of non-cost price factors such as accessibility, psychology, and delays. The presentation describes a simple computerized approach that allows the marketing manager to formally estimate the effect of incremental changes in rates on the firm's projected patterns of enrollment growth and net revenues. The changes in turn reflect underlying variations in the mix of pricing influences including psychological and other factors. Enrollment projections are crucial to the firm's financial planning and staffing. In the past, most HMO enrollment and revenue projections of this kind were notoriously unreliable. The approach described here makes it possible for HMOs to fine-tune their pricing policies. It also provides a formal and easily understood mechanism by which management can evaluate and reach consensus on alternative scenarios for enrollment growth, staff recruitment and capacity expansion.
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Managed care organizations, particularly HMOs, have emphasized disease prevention and early detection (screening) programs as a component of high-quality, cost-effective medical care. Studies in the 1980s found higher levels of utilization of screening by HMO enrollees compared with individuals enrolled in fee-for-service (FFS) plans, although this pattern is less clear in more recent reports. This paper reports on an analysis of a survey designed to determine awareness, compliance, and potential barriers to participating in common screening tests by adults living in Hillsborough County (greater Tampa), Florida. A random digit--dialing telephone survey of a stratified random sample of 500 adults over 18 years of age was conducted. Health plan enrollees were found to be younger, more likely to receive health insurance through an employer, and were more likely to have a regular source of health care. Few statistically significant differences, however, were detected in awareness of or compliance with recommended screening procedures between HMO and FFS enrollees in the study. Consistent with other recent research, these findings suggest that the changing nature of managed care, from traditional staff models toward IPA or network-hybrid models, has somewhat reduced HMOs' influence on prevention and screening services.