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Benefits and risks associated with managed care.pdf

More important in the face of unfavorable economic

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more important in the face of unfavorable economic development and budget austerity as well as rising costs associated with ever more common chronic diseases, R&D in medication, procedures and equipment and population aging.
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14 In our opinion, the main barriers to managed care provision in Slovakia include a vague definition of the extent of services paid for from public expenditure, lacking competition in the insurance market, inefficient management of large state-owned hospitals, high information asymmetry between health care providers and patients, insufficient oversight over and enforcement of treatment quality as well as a high concentration in the insurer and (to a certain extent) provider market. Addressing these barriers could help minimize the risks associated with managed care. In order to minimize these risks INEKO recommends: 1. A more precise and perhaps narrower definition of patient claims possible within publicly financed health care. A list of goods and services paid for by compulsory health insurance should be compiled and regularly updated, including detailed quality requirements such as maximum waiting time, technical and staff requirements, distance-from-provider requirements etc. The currently used catalogue of treatments may be used as a starting point. 2. More competition in the health insurance market. Possible measures include (1) di viding and at least partially privatizing VšZP and welcoming new companies into the market, (2) letting insurers create plans with varying deductibles and (3) introducing differentiated fixed nominal insurance fees, which would allow insurance companies to appeal to their clients. 3. More competition in the provider market. Possible measures include (1) privatization or long-term leasing of hospitals, (2) reversing the requirement that insurance companies conclude contracts with a set minimum provider network, etc. 4. Decreasing information asymmetry by providing patients with more information on the price and quality of services. Possible measures include (1) publishing regular insurer and provider rankings, including rankings of hospital departments and individual doctors, (2) introducing transparent receipts for goods and services, allowing patients to keep track of what they are paying for and how much. 5. Standardizing diagnostic and treatment procedures and substantiating insurance payments (e.g. by introducing a DRG system in hospitals). 6. Strengthening oversight over and enforcement of health care quality. Resolving the state’s conflict of interest is crucial, as the state -controlled regulator also regulates state-owned providers. Allowing private investment in state-owned providers would be a step in the right direction. 7. Strengthening oversight over possible concentration in the insurer and provider markets.
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15 9. Sources - CBO, 1994: Effects of Managed Care: An Update, Congressional Budget Unit Memorandum, March 1994, - Cutler, 1997: Managed Care and the Growth of Medical Expenditures, NBER Working Paper No. 6140, David Cutler, Louise Sheiner, 1997,
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  • Spring '16
  • Health Maintenance Organizations

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