Sociology of Medicine and Health CLASS 23

Sociology of Medicine and Health CLASS 23 - Class 23...

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Class 23 – Managed Care I. Major features of managed care/explicit rationing of treatment A. Utilization is monitored 1. Anything that is not an emergency B. Pre-authorization of treatment may be required C. Care is limited by 3 rd party – limited care = more money they make D. Choice of doctor is limited – especially @ the referral level II. Detailed example of managed care for mental illness hospitalization A. Patient shows up at hospital ER in crisis (usually by parent) B. Patient presents insurance card and is there for 23 hours to see if they are harmful to themselves or others, it also saves money by not being there for a full day C. Hospital calls to verify insurance 1. Want to check if th3ey used up there amount of treatment 2. If no insurance left, they are discharged you after 23 hours 3. If there is still insurance left, you will be there for 3-5days of inpatient treatment D. Patient admitted for 23 hours of “evaluation” E. First 23 hours F. Discharged after 3-5 days, but the given medication takes about 2 weeks
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Sociology of Medicine and Health CLASS 23 - Class 23...

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