Public, private health plans readjust for enrollees' health risks

Article Abstract:

Managed healthcare plans and Medicare and Medicaid officials are grappling with how best to adjust the incentives they offer patients with regard to financial risk. The incentives are said to attract low-risk patients at the detriment of high-cost needy enrollees. Some healthcare sources say that the use of risk adjusters to mathematically come up with the correct balance is not adequate. Medical acclaim in a certain area will attract needy patients in that area, pushing up costs; consequently, medical institutions perversely do not necessarily want to be known as the best.

Asset & Risk Management, Usage, Risk assessment, Economic aspects, Medical policy, Health policy

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What's important? Doctor's skills or being 'in network'?

Article Abstract:

Psychiatrists and other doctors have to strive for contracts with various health insurers in order to be sure that patients will be able to use their services. Managed care has placed more emphasis on doctors' ability to secure contracts than on their capability to help patients. It also has shifted the energy of other health care professionals from patient care to paperwork. Hospital physicians have discovered they cannot treat just any patient who seeks help.

Research and Development in the Social Sciences and Humanities, Psychology & Psychiatry, Management, Column, Psychiatric hospital care, Psychiatric hospitals

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Budget calls for savings but doesn't detail how

Article Abstract:

The 1997 federal balanced budget agreement offers few specifics regarding the allotment of Medicare funds, and several health care factions are leery of potential cuts that could cause setbacks in various health programs. The health care industry expects payment cuts for doctors and hospitals, perhaps totalling $100 billion. A total of $115 billion in Medicare savings is to be divvied up.

Legislative Bodies, Budget, Laws, regulations and rules, Finance, Budgeting, Budgets, Medicare

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