Patient Care & Managed Care

HMO'S, which arose during the 1970s, compete with indemnity insurance policy carriers; independent provider brass sections contract directly with utiliseers.

Among managed concern plans, the interrelationship mingled with the health benefit intermediary and the health fretting provider networks may vary considerably. For example, in that location are quin different kinds of HMO. These different categories are distinguished by the "organization that provides dish exposes and the exclusivity of the relationship in the midst of the intermediary and large medical examination groups" (Miller & Luft, 1994, pp. 1512-1518). For one, the prepaid group practice (PGP) involves an pocket relationship between the intermediary and the large medical group (e.g., Kaiser Foundation wellness Plan and the Permanente Medical Group). Second, with network HMOs, the relationship is not easy lay (e.g., Pacificare Health Systems). Third, staff HMOs--such as Group Health Co sherlock--directly employ physicians. The fourth type of HMO consists of the individual practice intimacy (IPA) (e.g., U.S. Healthcare, Inc.). With an IPA, the health benefit intermediary contracts with either solo or small-group practitioners. Lastly, the mixed-model HMO (e.g., Prudential Health Care Plans, Inc.) involves different relationships between the intermediary and the providers. Such a plan might, for instance, involve exclusive contracts wi

Williams, 0. A. (1993, June). Patient knowledge of operative care. Journal of the Royal Society of Medicine, 86, pp. 328331.

One method, in particular, by which HMOs reduce their health care expenditures involves the utilization of primary(a) care. Although there is little definitive evidence with regard to the qualitative effects of substituting primary care for specialty care, many hospitals ware adopted the "delivery model" (Bindman, 1994, pp. 78-81). Within these organizations, in-hospital physicians act as gatekeepers to allocate valuable health care resources.

Lee, T. H.; Pearson, S. D.; Johnson, P. A.; Garcia, T. B.; Weisberg, M. C.; Guadagnoli, E.; Cook, E. F., & Goldman, L. (1995, March 15).

adversity of information as an intervention to modify clinical management. A time-series trial of patients with acute chest pain. Annals of Internal Medicine, 122, pp. 434-437.

tally to an Institute of Medicine conference held in the late 1970s, the translation of primary care incorporates the following five components: Accessibility, accountability, comprehensiveness, continuity, and coordination. Accessibility involves service availability; whereas accountability relates to physician responsibility. Comprehensiveness, continuity, and coordination describe the entirety of primary care (Bindman, 1994, pp. 78-81).

Rates of readmission may also be use to assess health care quality. Approximately one out of every six or seven patients admitted to a hospital will experience a second admission inwardly a year. Furthermore, with Medicare beneficiaries, the readmission rate within 60 days of fill in can be as high as 22 to 27 percent. According to Corrigan & Martin (1992), multiple admissions may be a sign of either poor quality health care or inefficiently delivered care. The study noted the abundant seek that has been performed on the different patient and health system factors associated with readmission (Graham & Livesley 1983; Anderson &
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