5. *Possible new one: list of medications that can be provided for certain diagnoses 6. *Another possible one is: dentistry I) Blue cross and blue shield of NJ use Milliman guidelines 1. Now it is a public but also for-profit insurance company 2. Reduced hospital stays by 10% 3. Save $50 million/ year VI. Advantages of managed care A) Keeps kids out of hospital (develop normally) 1. Hospital is just for stabilizing a crisis 2. Kids needs stimulating environment with family, friends, educational opportunities B) Saves big $$ on inpatient treatment 1. Higher salary if no insurance C) More procedures done outpatient 1. This is good so you can avoid overnight hospital costs and iatrogenic infections VII. Disadvantages of managed care A) Gamesmanship by docs and hospitals ( this emphasize sickness ) 1. Hospital and insurance companies negotiate how long a person can stay 2. Hospital overemphasizes seriousness of illness 3. Insurance companies discount severity of symptoms
B) Limited treatment in 5 days 1. Hard to treat within given hospital stay because it’s difficult to gauge effectiveness of medication 2. Easier if outpatient psychiatric care was covered by insurance C) Higher workload on physicians 1. Have to do complex clinical evaluation which usually doesn’t have much medical value D) Adversarial relationship between hospital staff and insurance E) Hospitals have lower occupancy rates 1. 60% occupancy on average at hospitals, but hospitals have to keep up maintenance of those unused rooms in the event that a patient needs it This causes hospitals to go out of business or to merge with other hospitals
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- Spring '07
- Sociology, Physician, insurance companies