210class21

210class21 - Stephen Hansell, Ph.D. Department of Sociology...

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Stephen Hansell, Ph.D. Department of Sociology Institute for Health Research http://sakai.rutgers.edu [email protected] 609-203-2830
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Class 21 HMO s and Rationing
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D. Long stay patients may become "institutionalized“ 1. Progressive apathy 2. Loss of coping skills 3. Fear of being discharged
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I. Rationing influences medical care organization A. Demand for medical care always greater than supply 1. Rising demand cannot be satisfied 2. Rationing is inevitable
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B. We have always had rationing in some form! 1. Economic rationing 2. Implicit rationing 3. Explicit rationing
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II. Economic Rationing (Fee-for-service) A. Doc bills patient directly for treatment B. Claim-based rather than need-based C. You get only what you can pay for, or what your insurance will pay for D. Rich people get more, poor people get less or none
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E. Assumes free market automatically regulates supply and demand F. FFS escalates costs G. FFS has broken down H. Doc-patient interaction
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III. Implicit rationing A. Capitation B. Doc decides who gets care C. Built-in limitations on services
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IV. HMO example of implicit rationing
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This note was uploaded on 11/16/2011 for the course 920 210 taught by Professor Hansell during the Spring '08 term at Rutgers.

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210class21 - Stephen Hansell, Ph.D. Department of Sociology...

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