SEARCH · Search PubMed

Results for “Managed Competition”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 397 records · Page 22Linked to original sources

PubMed1999

Does managed care restrictiveness affect the perceived quality of primary care? A report from ASPN. Ambulatory Sentinel Practice Network.

BACKGROUND: The competitive managed care marketplace is causing increased restrictiveness in the structure of health plans. The effect of plan restrictiveness on the delivery of primary care is unknown. Our purpose was to examine the association of the organizational and financial restrictiveness of managed care plans with important elements of primary care, the patient-clinician relationship, and patient satisfaction. METHODS: We conducted a cross-sectional study of 15 member practices of the Ambulatory Sentinel Practice Network selected to represent diverse health care markets. Each practice completed a Managed Care Survey to characterize the degree of organizational and financial restrictiveness for each individual health care plan. A total of 199 managed care plans were characterized. Then, 1475 consecutive outpatients completed a patient survey that included: the Components of Primary Care Instrument as a measure of attributes of primary care; a measure of the amount of inconvenience involved with using the health care plan; and the Medical Outcomes Study Visit Rating Form for assessing patient satisfaction. RESULTS: Clinicians' reports of inconvenience were significantly associated (P < .001) with the financial and organizational restrictiveness scores of the plan. There was no association between plan restrictiveness and patient report of multiple aspects of the delivery of primary care or patient satisfaction with the visit. CONCLUSIONS: Plan restrictiveness is associated with greater perceived hassle for clinicians but not for patients. Plan restrictiveness seems to be creating great pressures for clinicians, but is not affecting patients' reports of the quality of important attributes of primary care or satisfaction with the visit. Physicians and their staffs appear to be buffering patients from the potentially negative effects of plan restrictiveness.

Adult↗

PubMed1996

Charity and community: the role of nonprofit ownership in a managed health care system.

As American medicine has been transformed by the growth of managed care, so too have questions about the appropriate role of nonprofit ownership in the health care system. The standards for community benefit that are increasingly applied to nonprofit hospitals are, at best, only partially relevant to expectations for nonprofit managed care plans. Can we expect nonprofit ownership to substantially affect the behavior of an increasingly competitive managed care industry dealing with insured populations? Drawing from historical interpretations of tax exemption in health care and from the theoretical literature on the implications of ownership for organizational behavior, we identify five forms of community benefit that might be associated with nonprofit forms of managed care. Using data from a national survey of firms providing third-party utilization review services in 1993, we test for ownership-related differences in these five dimensions. Nonprofit utilization review firms generally provide more public goods, such as information dissemination, and are more "community oriented" than proprietary firms, but they are not distinguishable from their for-profit counterparts in addressing the implications of medical quality or the cost of the review process. However, a subgroup of nonprofit review organizations with medical origins are more likely to address quality issues than are either for-profit firms or other nonprofit agencies. Evidence on responses to information asymmetries is mixed but suggests that some ownership related differences exist. The term "charitable" is thus capable of a definition far broader than merely the relief of the poor. While it is true that in the past Congress and the federal courts have conditioned the hospital's charitable status on the level of free or below cost care that it provided for indigents, there is no authority for the conclusion that the determination of "charitable" status was always so limited. Such an inflexible construction fails to recognize the changing economic, social and technological precepts and values of contemporary society. -Circuit Court of Appeals, District of Columbia, Eastern Kentucky Welfare Rights Organization v. Simon (1974).

Charities↗

PubMedDate not supplied

How to hire the right CIO.

As the role of technology in healthcare management and delivery continues to expand, the market for qualified chief information officers grows ever more competitive. Management teams in the market for a CIO must choose quickly-but they must also choose wisely.

Administrative Personnel↗

PubMed1989

What can Europeans learn from Americans?

In a wide-ranging look at many aspects of health care financing and delivery, the concepts of glasnost and perestroika are used as a framework for presenting ideas from the American system that may have value for European health care planners. These include more uniform approaches to data collection and cost reporting, patient outcome studies, evaluation of service and access standards, publication of information, quality assurance review, decentralization and independent institutions, prepaid group practice, demonstrations and experiments, and managed competition. Suggestions are offered for making health care systems on both sides of the Atlantic more manageable, efficient, and responsive.

Cross-Cultural Comparison↗

PubMedDate not supplied

Teamwork in health care: opportunities for gains in quality, productivity, and competitive advantage. What works, what doesn't, and why.

Wholesale political, economic, and social change is pressuring health-care organizations to reinvent themselves as they enter a new arena of managed competition. Survival is at stake. Will belt-tightening efforts, combined with structural changes and strategic alliances, achieve the necessary improvements in efficiency and help to secure an adequate patient base? It seems reasonable to expect that health-care institutions can realize the major gains in quality, productivity, efficiency, and competitive edge that organizations in the manufacturing and service industries have enjoyed for the past several years. It seems like a logical next step for health-care organizations to deploy proven methods--such as work redesign, team-based structures, and empowered workforces--that have helped to restore competitiveness to many industrial and service firms. This article describes how to organize teams at all levels and accelerate their development to achieve important organizational objectives--such as improving quality, productivity, and efficiency--while increasing employee satisfaction. Pioneering workplace innovations are reviewed to demonstrate how high-involvement teams integrating strategic planning, research, and health-care delivery processes are not only possible but highly desirable. Enhanced quality, improved productivity, greater efficiency, and employee satisfaction all translate to an undeniable competitive advantage.

Decision Making, Organizational↗

PubMed1993

Health care reform and emergency department services.

EDs are the access of last resort for many Americans, and cost-driven reform initiatives that restrict ED utilization could deter people from seeking necessary and timely medical services. The experience in Canada under universal coverage suggests that major reform could lead to a substantial increase in ED utilization, especially in view of the relative shortage of primary care physicians in the United States. Many hospitals could face short-term overcrowding problems that compromise the quality of care provided in EDs, and rural hospital EDs face specific and unique problems relative to competition and cost efficiency. Integration of emergency services into comprehensive health delivery systems under the concept of managed competition is essential to ensure access and cost-effective delivery of services. The hospital ED may well serve as an important focal point in the development of alternative physician-hospital relationships.

Emergency Service, Hospital↗

PubMed1991

Universal health insurance through incentives reform.

Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

Aged↗

PubMed1997

Implementing programs for chronic illness management: the case of hypertension services.

BACKGROUND: This article describes the process by which HealthSystem Minnesota (a vertically integrated health care organization), functioning in a competitive managed care environment, has been implementing a hypertension services program. The program involves a team approach to care, with emphasis on patient participation in treatment; decentralized care delivery by nurse coordinators at primary care practice sites; ongoing training and education for patients and providers; and the continuous monitoring and evaluation of patient outcomes and satisfaction. JOB-LEVEL ISSUES: A variety of issues, such as the role and responsibilities of the nurse coordinator, became evident as the program moved towards operational status at four primary care practice sites, which prolonged the implementation period. PROCESS-LEVEL ISSUES: Issues relating to work process changes were more complicated to resolve and required, in some cases, changes in the proposed model. The most significant process-level issues related to educating physicians about the program to secure their participation and support. ORGANIZATION-LEVEL ISSUES: Such issues, which were the most difficult for program implementors to anticipate and resolve, included an organizational culture that emphasized decision making autonomy at primary practice sites. In part, the difficulty encountered in resolving organization-level issues reflected the implementors' lack of awareness of the strength or complexity of the environmental pressures facing the organization, as well as a lack of sensitivity to nuances relating to organizational culture. MOVING AHEAD: Two groups of hypertensive patients--at the implementation and comparison sites--will be compared with respect to satisfaction with care, clinical outcomes, and costs. Expansion of the model to patients with other chronic conditions is under consideration.

Case Management↗

PubMed1993

Fixing the individual health insurance market.

The individual health insurance market is in crisis. Among the possible options for reform, a managed competition approach offers the broadest, most comprehensive solution.

Competitive Medical Plans↗

PubMed1994

Strategies for implementing global budgets.

Implementing global budgets requires setting a desired level of spending as well as establishing a set of policies to assure the budget will be met. Four alternative approaches are analyzed: one relies on all-payer rate setting coupled with volume controls; the second is a system of premium regulation that controls both the levels and rates of insurance premium increase; in another system, price competition among insuring organizations limits growth in spending while incorporating a global budget that limits the aggregate costs of all premiums; finally, either managed competition or premium regulation is combined with all-payer rate setting. The fourth model is singled out for its ability to control costs. An independent policy toward capital expenditures could increase the likelihood of success under any of the strategies.

Budgets↗

PubMed1994

Mental health services under health reform: the less government, the better.

Federal and state governments are now rapidly preparing to restructure the delivery and financing of health care services in the United States. Unfortunately, the bureaucratic structures promised under managed competition do not acknowledge the successes of private sector "market-regulated" programs. A needlessly costly and burdensome system could evolve that will undermine the goals of improved access and quality of care.

Competitive Medical Plans↗

PubMed1995

Casemix: the building blocks.

This paper distinguishes three separate ways in which casemix measurement serves as a foundation for hospital and health system reform. At the hospital level, diagnosis related groups provide a means of describing kinds of acute inpatient care which in turn facilitates utilisation review activities essential to modern clinical and financial management. At the system level, casemix adjusters such as diagnosis related groups provide the basis for comparisons of productive efficiency across institutions, and reduce the risk of adverse funder reactions to higher per case costs which are attributable to differences in casemix. States are increasingly using casemix as the basis for funding hospitals in order to reduce non-casemix related differences. Finally, health reform experiments in using market-like mechanisms (such as managed competition, purchaser-provider split) require at a minimum that the product purchased be precisely specified, and that clinical risks of cost overruns be equalised amongst insurers or providers.

Australia↗

PubMedDate not supplied

Part 2, Conflict management. Managing low-to-mid intensity conflict in the health care setting.

Physician executives face low to mid-level intensity conflicts, day-to-day issues and problems associated with pressures and changes in the health care environment. Such conflicts can be sorted on the basis of relationship, duration, and intensity. The authors apply the five major modes of conflict management--competition, avoidance, compromise, accommodation, and collaboration--to specific scenarios taken from their work in health care and suggest guidelines for managing conflicts with peers, supervisees, and authority figures. Thorough preparation and a portfolio of skills build flexibility through the conflict management process. In part 1 of this article series, the authors presented the conflict management checklist, a diagnostic tool for assessing conflict in organizations.

Conflict, Psychological↗

PubMed2000

The new millennium: health care evolution in the 21st century.

The health care industry has evolved tremendously in recent years. It will experience even greater changes in the 21st century. Evolution will occur in health care delivery, system formation, and the roles played by government, the insurance industry, and organized business. Major focuses will be on management, competition, and quality.

Continuity of Patient Care↗

PubMed1993

VIP interview: Paul M. Ellwood, Jr., M.D.

Paul Ellwood, Jr., M.D., is president of Health Outcomes Institute, a nonprofit health policy research organization, and President of the Jackson Hole Group in Teton Village, Wyoming, a health care reform policy think tank. He has been called one of the most important figures in American health care in the last half century. Dr. Ellwood has been a leader in introducing competition into the marketplace through health maintenance organizations (HMOs) and preferred provider organizations (PPOs); encouraging the business coalition movement; developing medical staff-hospital joint venture approaches to integrating health delivery, and installing the Outcomes Management System for payors, patients, and providers. He is now concentrating on working with health care leaders of the Jackson Hole Group to devise and implement The 21st Century American Health System, a comprehensive proposal for health care policy reform in the private and public sectors. Their objective is to ensure universal insurance coverage, managed competition, and health outcomes accountability.

Managed Care Programs↗

PubMed1989

A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (1).

America's health care economy is a paradox of excess and deprivation. We spend more than 11 percent of the gross national product on health care, yet roughly 35 million Americans have no financial protection from medical expenses. To an increasing degree, the present financing system is inflationary, unfair, and wasteful. In its place we need a strategy that addresses the whole system, offers financial protection from health care expenses to all, and promotes the development of economical financing and delivery arrangements. Such a strategy must be designed to be broadly acceptable in our society. To remedy the deprivation, we propose that everyone not covered by Medicare, Medicaid, or some other public program be enabled to buy affordable coverage, either through their employers or through a "public sponsor." To attack the excess, we propose a strategy of managed competition in which collective agents, called sponsors, such as the Health Care Financing Administration and large employers, contract with competing health plans and manage a process of informed cost-conscious consumer choice that rewards providers who deliver high-quality care economically.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1990

Case six. Introducing product line management in a multi-institutional healthcare organization.

This case reports a major shift in growth orientation pursued by a multi-institutional system--systemwide product line management. Competitive response to one environmental disruption led to the initiation of a year-long study to re-evaluate the corporation's mission, goals, strategies, growth and action orientations and organizational structure in light of the dramatic changes occurring in healthcare delivery. Of particular interest in this case is the connectedness between growth and action orientations, organizational culture, management style and organizational structure.

Decision Making, Organizational↗

PubMed1998

Merging HMOs into an all-payer system: a model to pursue?

An almost unending debate over the future shape of America's health care system increasingly focuses on the continuum between managed competition and government regulations, and the question: What is right for the United States? The Maryland all-payer, rate setting system for its 50 hospitals, where over a third of the state's population is enrolled in managed care plans, is used as an example of relatively successful blending of competitive and regulatory strategies. This article concludes with the theme that given America's penchant for compromise, competitive and regulatory approaches can coexist in a pluralistic health system that constrains the use of services and costs, and enhances access and the quality of patient care.

Economic Competition↗