The search for checks and balances

Article Abstract:

It has been relatively difficult in the US to install a system of checks and balances to ensure that managed care plans provide good quality care while reducing costs. Quality care is promoted by databases such as the HEDIS database, which compiles data on how well HMOs meet certain goals such as immunization and compliance with practice guidelines. Patient dissatisfaction has led to regulation of managed care at the state and federal level. The American Medical Association created a division to help physicians challenge managed care companies. However, extensive regulation is expensive and uses up enormous resources.

Analysis, Laws, regulations and rules, Medical care, Quality management, Medical care quality, Managed care plans (Medical care), Health maintenance organizations

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The American health care system: health insurance coverage

Article Abstract:

Unless a national health insurance system emerges, the number of uninsured or underinsured Americans will continue to rise. As of 1997, 16% of Americans had no health insurance. The most important reason for this is the inability or unwillingness of employers in the private sector to provide health insurance to their employees. Premiums are rising and many poor Americans will lose Medicaid coverage due to welfare reform. Older Americans who are shifted from Medicare to managed care may lose benefits. The Children's Health Insurance Program will probably cover only 2 million of the 10.6 million uninsured childen.

Statistics, Medically uninsured persons, Health insurance

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