Managed Care : What It Is and How It Works (2ND)

Managed Care : What It Is and How It Works (2ND)

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  • 製本 Paperback:紙装版/ペーパーバック版/ページ数 329 p.
  • 言語 ENG
  • 商品コード 9780763724986
  • DDC分類 362.10425

Full Description


A managed care expert overviews the history, structure, regulation, and issues of the complex US health care system. This second edition work was originally published by Aspen in 2002. Much of the information is distilled from another of the doctor's books, The Managed Care Handbook, 4th ed. An extensive glossary is included, but there are no referNER(01): GB

Table of Contents

Preface                                            ix
The Origins of Managed Care 1 (24)
Managed Care: The Early Years (Pre--1970) 1 (4)
The Adolescent Years of Managed Care: 5 (7)
1970--1985
Managed Care as a Mature Concept: 12 (9)
1985--1995
Managed Care in Recent Times 21 (3)
Conclusion 24 (1)
Types of Managed Care Organizations and 25 (52)
Their Structure
Types of Bearing Risk for Medical Costs 26 (11)
Payer-Based Managed Care 37 (12)
Integrated Delivery Systems 49 (14)
Governance and Management of MCOs 63 (12)
Conclusion 75 (2)
Network Management and Reimbursement 77 (54)
General Contracting Issues 78 (6)
Physicians 84 (20)
Hospitals and Institutions 104(23)
Network Maintenance and Management 127(2)
Conclusion 129(2)
Medical Utilization and Quality 131(26)
Prevention and Wellness 132(1)
Basic Utilization Management 133(6)
External Review Programs 139(2)
Disease and Case Management 141(2)
Ancillary and Pharmaceutical Services 143(5)
Quality Management 148(5)
Total Quality Management 153(2)
Conclusion 155(2)
Internal Operations 157(38)
Marketing and Sales 158(10)
Enrollment and Billing 168(2)
Claims 170(9)
Member Services 179(5)
Finance and Underwriting 184(9)
Information Systems 193(1)
Conclusion 194(1)
Medicare and Medicaid 195(20)
Medicare 196(6)
Reimbursement of Medicare+Choice MCOs 202(1)
Special Requirements for Medicare+Choice 203(8)
MCOs
Medicaid 211(3)
Conclusion 214(1)
Regulation and Accreditation in Managed Care 215(28)
State Regulation 216(8)
The Health Insurance Portability and 224(13)
Accountability Act
Self-Insured Employers and the Employee 237(1)
Retirement Income Security Act
Accreditation of Managed Care 238(4)
Organizations
Conclusion 242(1)
Epilogue: Managed Health Care at the Millennium 243(16)
Glossary 259(50)
Index 309