Medicine+and+Money - 1. Kinds of insurance coverage...

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Medicine, Money and Managed Care I. Introduction: health care shaped by struggle of two countervailing powers A. Payers who attempt to control costs B. Providers who seek to maximize profits II. 3 related changes A. Growth of medical technologies 1. Kinds of medical technology Diagnostic technologies Therapeutic technologies Reproductive technologies 2. Why medical technologies? 3. Promises of new medical technologies 4. Perils if new technologies 5. Allocating scarce resources B. Transformation of hospital care 1. Payers struggle to control costs: changes in reimbursement (DRG’s) 2. De-hospitalization and care transfers 3. Corporatization of hospitals and outpatient care C. Growth of managed care
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Unformatted text preview: 1. Kinds of insurance coverage Traditional indemnity PPO HMO: Prepaid group practice IPA/ Network model 2. Why managed care? 3.How HMOs control costs Educational techniques (e.g., practice guidelines, stats. on practice patterns Incentives (salaries, capitation) Sanctions/physician selection Utilization management 4. What is the impact of managed care on: The medical profession Cost and quality Medical decision making Medical ethics The doctor-patient relationship 5. Managed care and the fate of HMOs Recent shift from HMOs to PPOs Why the shift? Consequence: costs have risen .....
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Medicine+and+Money - 1. Kinds of insurance coverage...

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