Asunto(s)
Redes Comunitarias/legislación & jurisprudencia , Programas Controlados de Atención en Salud/legislación & jurisprudencia , Medicare Part B/legislación & jurisprudencia , Presupuestos/legislación & jurisprudencia , Capitación , Redes Comunitarias/economía , Redes Comunitarias/normas , Administración Financiera , Concesión de Licencias , Programas Controlados de Atención en Salud/economía , Medicare Part B/organización & administración , Gestión de Riesgos , Estados Unidos , United States Dept. of Health and Human ServicesAsunto(s)
Sistema de Pago Prospectivo/economía , Salarios y Beneficios/legislación & jurisprudencia , Áreas de Influencia de Salud/economía , Grupos Diagnósticos Relacionados/economía , Medicare/economía , Personal de Hospital/economía , Método de Control de Pagos/métodos , Salarios y Beneficios/clasificación , Estados UnidosRESUMEN
Literally dozens of comprehensive national healthcare reform bills are pending in Congress. In capsule, here are the main plans under discussion.
Asunto(s)
Política de Salud/tendencias , Organización de la Financiación/métodos , Organización de la Financiación/tendencias , Política de Salud/economía , Estados UnidosRESUMEN
This article summarizes major recent initiatives by the Medicare and Medicaid programs to increase the number of their beneficiaries who enroll in managed care plans. It reviews the major problems encountered to date as well as recent programmatic improvements. Finally, it offers a prognosis as to the impact of these developments on HMOs, providers, and the health care system in general.
Asunto(s)
Atención a la Salud/tendencias , Programas Controlados de Atención en Salud/tendencias , Medicaid/organización & administración , Medicare/organización & administración , Predicción , Estados UnidosRESUMEN
Major changes in the Medicare program mandated by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) became effective in 1985 and included the introduction of a capitated system for reimbursing health maintenance organizations (HMOs) for health care services provided to enrolled Medicare beneficiaries. Risk contracts with HMOs allowed the enrollment of some 900,000 individuals by May of 1987. The program has witnessed some variability in results including the Health Care Financing Administration's (HCFA's) May 1987 termination of its risk contract with International Medical Centers, Inc., a Florida-based HMO serving 150,000 subscribers, because of a number of problems, including quality of care. Recent Administration proposals would create a "private health plan option" (PHPO) with capitation and managed care provisions for all Medicare beneficiaries. This proposal would allow employers (and other entities not eligible for TEFRA risk contracts) to provide group health benefits to retirees with costs reimbursed on a capitated basis.