Health insurance plans from the consumer's point of view: the good one and the bad one

Article Abstract:

Two personal experiences with health maintenance organizations are described. In one scenario a patient with a brain tumor received immediate access to specialized care and well-managed follow-up treatment. In the other, the insurance company denied coverage for a test recommended by its own specialist until the consumer contacted a company executive. The lesson is that health plans differ and costs are not always an indication of quality. The health care marketplace offers nursing leaders an opportunity to improve patient care at administrative levels.

Management, Personal narratives, Health maintenance organizations, Nurse administrators

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From the editor

Article Abstract:

The health care environment is experiencing a social revolution. Cuts in nursing positions have affected administrators as well as clinical staff as managed care health plans pressure hospital to cut costs. Some former health care executives have becoming consultants recommending further cuts. Data is needed on how these changes in nursing are affecting patient outcomes and nursing quality. Nurses are concerned that commerce rather than caregiving is driving their profession.

Editorial, Analysis, Economic aspects, Influence, Nursing, Medical care, Cost of, Health care costs, Health care reform

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