Ethics are important in managed care decisions; the "culture" of a managed care organization - its dedication to quality care combined with financial incentives - will determine its success

Article Abstract:

Capitated payment systems are often criticized on ethical grounds, in that they supposedly provide an incentive for providers to boost income through limiting access to health care. However, there is no documented data to prove such a theory, and the necessary evaluative data will not be available anytime soon. The managed care industry must, therefore, develop a consensus on what treatments and procedures are medically necessary and appropriate and work towards a team environment where costs are held down by a culture of quality combined with physician incentives.

Medical care, Quality management, Medical care quality, Ethical aspects, Medical care, Cost of, Health care costs, Control, Capitated payment systems (Medical care)

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U.S. managed care in demand overseas

Article Abstract:

Managed health care companies are hoping that they can expand into overseas markets where socialized medicine is currently working. Many countries, such as Chile, Saudi Arabia, and South Africa, that have poor or underprivileged health systems, are good targets for US-style managed health care systems. European countries with established social medicine programs may consider using some aspect of managed care to help make costs competitive. US companies are still too occupied with domestic market wars to mount a long campaign in overseas markets.

Health Care and Social Assistance, Public Health Care, Direct Health and Medical Insurance Carriers, Health Programs-Total Govt, Administration of Human Resource Programs, Health Plan Administration, Foreign operations, Finance, Health care industry, Public health, Health insurance industry, Socialized medicine

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A look at formularies: prescription for success?

Article Abstract:

Many health maintenance organizations (HMO) are using drug formularies to manage health care expenditures. Establishing effective formularies while maintaining patient care requires the creation of best practice and clinical guidelines and a standardization of care. HMOs should employ pharmacy-benefit managers to analyze prescription utilization and recommend life style modifications for patients.

Pharmaceutical Preparation Manufacturing, Pharmaceutical preparations, Ethical Preparations, Management, Medicine, Drugs, Prescription drug plans, Medical formularies

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