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Managed competition of alternative delivery systems 总被引:1,自引:0,他引:1
A Enthoven 《Journal of health politics, policy and law》1988,13(2):305-321
The markets for health insurance and health care are not naturally competitive: they are susceptible to many forms of market failure. Health plans and consumers may use strategies that lead to inequity and inefficiency. But experience with successful models of competition suggests that tools are available to enable sponsors (active collective agents on the demand side who contract with health plans to structure and manage competition) to use competition to achieve a reasonable degree of efficiency and equity for their sponsored populations. All this implies a more complex, dynamic, and sophisticated view of competition than one usually finds in apologia for free markets. A free market is not possible in health insurance. 相似文献
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This paper reviews the historical trends in the regulatory and competitive approaches to containment of health care costs, covering efforts in both public and private sectors. The current interest in the potential of private-sector initiatives to stimulate competition in health care insurance and provider markets is highlighted. Since neither the workings of competition in health care nor the role and impact of the private sector in stimulating such competition are well understood, the concluding section discusses important research issues surrounding these topics. 相似文献
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While there have been no reported cases as yet on the subject of ERISA preemption of claims arising from utilization review decisions by providers, it will unquestionably be a significant issue facing providers that participate in capitated arrangements. If preemption is determined not to be available, providers will be exposed to risks from which health plans are currently shielded. Providers conducting utilization review should be following this issue as it develops, but should also be obtaining insurance for this risk to the extent it is available (e.g., it will not be available for punitive damages). Providers should also consider negotiating provisions in their contracts with health plans to the effect that any utilization review conducted by the provider is on behalf of the health plan and that the provider's utilization review activities will be covered under the health plan's liability insurance. 相似文献
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The Federal Trade Commission and Department of Justice 2004 report Improving Health Care: A Dose of Competition expresses a clear allegiance to competition as the organizing principle for health care. In Europe, by contrast, the key organizing principle of health care systems is solidarity. Solidarity means that all have access to health care based on medical needs, regardless of ability to pay. This is not to say that competition is not important in Europe, but competition must take place within the context of solidarity. This article critiques the report from a European perspective, describes the role of competition in Europe (focusing in particular on European Union law), and suggests that the United States could learn from the European perspective. 相似文献
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We describe three unusual cases of suicide committed by health care workers. The aim of this paper was to analyze and evaluate the evidence of general diagnostic elements of poisoning in these cases. 相似文献
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Simpson TL Moore SA Luterek J Varra AA Hyerle L Bush K Mariano MJ Liu CF Kivlahan DR 《Journal of interpersonal violence》2012,27(6):1005-1022
Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether DESNOS severity was associated with greater nonmental health medical care costs in veterans receiving mental health care. Participants were 106 men and 105 women receiving VA outpatient mental health treatment. A standardized interview assessed DESNOS severity. The dependent variables consisted of primary and specialty medical treatment costs. Sequential zero-inflated negative binomial regression was used to evaluate the variance in medical costs accounted for by DESNOS severity, controlling for PTSD severity and established predisposing, enabling, and need-based health care factors. Contrary to our hypothesis, in fully adjusted models, DESNOS severity independently added a significant amount of variance to lower specialty medical care costs, whereas PTSD did not consistently account for significant variance in medical care costs. Greater DESNOS severity appears to be associated with lower specialty medical care costs but not primary care costs. These findings may indicate that patients with DESNOS symptoms are at risk for being underreferred for specialty care. 相似文献
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Health care staff are instrumental in prisons given their roles in aiding security and the growing demand for medical services among prisoners. Unfortunately, little attention has been paid to this prison staff subpopulation. This study examined perceptions of supervision among 424 prison health care staff in the Federal Bureau of Prisons. Participants felt that prison supervisors were most effective in clarifying expectations and least effective in giving feedback for performance, involving staff in planning, and extending job autonomy. Using hierarchical linear models (HLM), some unique findings emerged. Efficacy in dealing with inmates was the strongest predictor variable: health care staff who felt more positive and effective with inmates had more favorable feelings toward supervision. Staff working in high- and medium-security prisons had more positive feelings toward supervision than those in minimum security, and younger staff had more favorable attitudes toward supervisors than older staff. The implications of these findings and directions for future research are discussed. 相似文献
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This paper focuses on the distribution of health care costs among the elderly. Four revenue sources are considered: income taxes, payroll taxes, user fees, and insurance premiums. The empirical work shows that the heavy reliance on direct payments as a means of collecting revenues among the elderly makes their contribution to the health care financing structure more regressive than for the nonelderly. 相似文献
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