Law and Practice of Private Health Insurance and Managed Care
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Diploma Thesis from the year 2000 in the subject Health Science, grade: 1,0, Technical University of Darmstadt (Unbekannt), course: Zivilrecht, Deutsches und Internationales, language: English, abstract: Inhaltsangabe:Abstract:A true revolution has taken place in the financing of health care in America. Today, managed care is dominating the way Americans receive and pay for their health care.With the rise of managed care medicine has been wrenched out of its atomized world of solo physician practices and community hospitals and has been transformed into a modern industry of giant for-profit co...
Diploma Thesis from the year 2000 in the subject Health Science, grade: 1,0, Technical University of Darmstadt (Unbekannt), course: Zivilrecht, Deutsches und Internationales, language: English, abstract: Inhaltsangabe:Abstract:
A true revolution has taken place in the financing of health care in America. Today, managed care is dominating the way Americans receive and pay for their health care.
With the rise of managed care medicine has been wrenched out of its atomized world of solo physician practices and community hospitals and has been transformed into a modern industry of giant for-profit companies traded on Wall Street. The current marketplace is characterized by mergers, acquisitions and the establishment of giant multi-billion dollar healthcare networks. Hospitals and managed care plans run big advertisement campaigns in the media, praising their products and services in order to get the biggest share possible of the $1.1 trillion America spends on health care each year. All parties involved in providing health care lobby for their interests at all levels of political decision-making in order to influence legislators and policymakers.
Today s health care market changes quickly and at a high rate. New variations of managed care arise constantly making any analysis of managed care an ongoing game of "catch-up" with the marketplace. While writing this paper, for example, UnitedHealthcare dropped one of the major managed care instruments, utilization review, to address public s concerns and pending legislation. This paper will take a snapshot of managed care on the eve of the new millennium by using the most recent information available.
After this introduction, the paper will give a description of the current American health care system in chapter two (The U.S. Health Care System). Then, the paper will focus on two aspects: A detailed description of managed care in chapter three (Managed Care) and an introduction of the main issues connected with this way of providing health care in chapter four (Managed Care issues). The paper will argue in chapter five (Results and Future Developments), that managed care of the future will be a light version of what is currently existing, resulting in less strict restrictions and more freedom for patients and doctors.
Finally, the report will focus on recent developments in Germany, where policy-makers have started to adopt particular elements of managed care. In chapter six (Managed Care Approaches in Germany), the paper will argue, that Germany should pay more attention to the American experiences regarding managed care in order to prevent harm for patients in Germany.
Inhaltsverzeichnis:Inhaltsverzeichnis:
AcknowledgementsV
Tables and FiguresVI
AbbreviationsVII
1.Introduction1
2.The U.S. Health Care System3
2.1History of U.S. Health Insurance3
2.2Health Plan Options6
2.2.1Indemnity Insurance6
2.2.2Managed Care7
2.2.3Medical Savings Account8
2.2.4Medicare11
2.2.5Medicaid14
2.3Coverage16
2.3.1Employer-Sponsored Coverage16
2.3.2Individual Insurance19
2.3.3Government Sponsored Coverage20
2.3.4The Uninsured20
2.4The Rise of Managed Care21
2.5Current Marketplace24
2.6Summary26
3.Managed Care27
3.1Definitions27
3.1.1Managed Care27
3.1.2Managed Care Organization28
3.1.3Purchaser29
3.1.4Members29
3.1.5Heath Care Professionals29
3.1.6Administrative Organizations30
3.2Managed Care Organizations31
3.2.1Health Maintenance Organization31
3.2.2Preferred Provider Organization36
3.2.3Provider-Sponsored Organization37
3.3Managed Care Products38
3.3.1Closed-Panel HMO38
3.3.2Exclusive Provider Organization39
3.3.3Open-Access HMO39
3.3.4Point of Service Plan39
3.3.5Open-Access PPO40
3.3.6Other Products40
3.3.7...
A true revolution has taken place in the financing of health care in America. Today, managed care is dominating the way Americans receive and pay for their health care.
With the rise of managed care medicine has been wrenched out of its atomized world of solo physician practices and community hospitals and has been transformed into a modern industry of giant for-profit companies traded on Wall Street. The current marketplace is characterized by mergers, acquisitions and the establishment of giant multi-billion dollar healthcare networks. Hospitals and managed care plans run big advertisement campaigns in the media, praising their products and services in order to get the biggest share possible of the $1.1 trillion America spends on health care each year. All parties involved in providing health care lobby for their interests at all levels of political decision-making in order to influence legislators and policymakers.
Today s health care market changes quickly and at a high rate. New variations of managed care arise constantly making any analysis of managed care an ongoing game of "catch-up" with the marketplace. While writing this paper, for example, UnitedHealthcare dropped one of the major managed care instruments, utilization review, to address public s concerns and pending legislation. This paper will take a snapshot of managed care on the eve of the new millennium by using the most recent information available.
After this introduction, the paper will give a description of the current American health care system in chapter two (The U.S. Health Care System). Then, the paper will focus on two aspects: A detailed description of managed care in chapter three (Managed Care) and an introduction of the main issues connected with this way of providing health care in chapter four (Managed Care issues). The paper will argue in chapter five (Results and Future Developments), that managed care of the future will be a light version of what is currently existing, resulting in less strict restrictions and more freedom for patients and doctors.
Finally, the report will focus on recent developments in Germany, where policy-makers have started to adopt particular elements of managed care. In chapter six (Managed Care Approaches in Germany), the paper will argue, that Germany should pay more attention to the American experiences regarding managed care in order to prevent harm for patients in Germany.
Inhaltsverzeichnis:Inhaltsverzeichnis:
AcknowledgementsV
Tables and FiguresVI
AbbreviationsVII
1.Introduction1
2.The U.S. Health Care System3
2.1History of U.S. Health Insurance3
2.2Health Plan Options6
2.2.1Indemnity Insurance6
2.2.2Managed Care7
2.2.3Medical Savings Account8
2.2.4Medicare11
2.2.5Medicaid14
2.3Coverage16
2.3.1Employer-Sponsored Coverage16
2.3.2Individual Insurance19
2.3.3Government Sponsored Coverage20
2.3.4The Uninsured20
2.4The Rise of Managed Care21
2.5Current Marketplace24
2.6Summary26
3.Managed Care27
3.1Definitions27
3.1.1Managed Care27
3.1.2Managed Care Organization28
3.1.3Purchaser29
3.1.4Members29
3.1.5Heath Care Professionals29
3.1.6Administrative Organizations30
3.2Managed Care Organizations31
3.2.1Health Maintenance Organization31
3.2.2Preferred Provider Organization36
3.2.3Provider-Sponsored Organization37
3.3Managed Care Products38
3.3.1Closed-Panel HMO38
3.3.2Exclusive Provider Organization39
3.3.3Open-Access HMO39
3.3.4Point of Service Plan39
3.3.5Open-Access PPO40
3.3.6Other Products40
3.3.7...
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