Medical los ratios under scrutiny

Article Abstract:

Procedures for calculating medical loss and administrative expense ratios and corresponding trends among managed care organizations (MCOs) have been presented. MCOs calculate these ratios by dividing health care costs or administrative costs by total income. The MCO realizes a profit if the ratios add up to less than 100%. Ratios vary by geographical region, by organizational efficiency and age, and by MCO membership size. Ratio variations have sparked much political debate.

Statistics, Business losses

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Will managed care's role in Medicare expand?

Article Abstract:

Medicare will have to be dramatically restructured if it is to encourage greater involvement by managed care plans and get more beneficiaries to enroll in HMOs. Though managed care has expanded its role in Medicare the program is rapidly losing money and may have no money by the year 2001. Increased HMO enrollment and more managed care plans becoming Medicare risk contractors will help a redesigned Medicare program save a greater amount of money.

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Unsettling times for public health care providers

Article Abstract:

Managed care is rapidly becoming the norm for health care delivery, and states are restructuring their delivery systems to accomodate competition and reduced budgets. State are increasingly turning their Medicaid and Medicare patients to managed care plans, and merging public hospitals and clinics into a single public benefit corporation. Public health care providers need to learn how to collaborate with private health plans.

Social policy, Public health, Medical policy, Health policy, Medicaid, State government

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