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Controlling costs and changing patient care? [[electronic resource] ] : the role of utilization management / / Committee on Utilization Management by Third Parties, Division of Health Care Services, Institute of Medicine ; Bradford H. Gray and Marilyn J. Field, editors
| Controlling costs and changing patient care? [[electronic resource] ] : the role of utilization management / / Committee on Utilization Management by Third Parties, Division of Health Care Services, Institute of Medicine ; Bradford H. Gray and Marilyn J. Field, editors |
| Pubbl/distr/stampa | Washington, D.C., : National Academy Press, 1989 |
| Descrizione fisica | 1 online resource (320 p.) |
| Disciplina | 338.4/33621/0973 |
| Altri autori (Persone) |
GrayBradford H. <1942->
FieldMarilyn J (Marilyn Jane) |
| Soggetto topico |
Cost control
Health services administration - United States |
| Soggetto genere / forma | Electronic books. |
| ISBN |
1-280-21445-7
9786610214457 0-309-54309-6 0-585-14457-5 |
| Formato | Materiale a stampa  |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Record Nr. | UNINA-9910455908903321 |
| Washington, D.C., : National Academy Press, 1989 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
| ||
Controlling costs and changing patient care? : the role of utilization management / / Committee on Utilization Management by Third Parties, Division of Health Care Services, Institute of Medicine ; Bradford H. Gray and Marilyn J. Field, editors
| Controlling costs and changing patient care? : the role of utilization management / / Committee on Utilization Management by Third Parties, Division of Health Care Services, Institute of Medicine ; Bradford H. Gray and Marilyn J. Field, editors |
| Pubbl/distr/stampa | Washington, D.C. : , : National Academy Press, , 1989 |
| Descrizione fisica | 1 online resource (viii, 312 pages) : illustrations |
| Disciplina | 338.4/33621/0973 |
| Altri autori (Persone) |
GrayBradford H. <1942->
FieldMarilyn J (Marilyn Jane) |
| Soggetto topico |
Cost control
Health services administration - United States |
| ISBN |
1-280-21445-7
9786610214457 0-309-54309-6 0-585-14457-5 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Record Nr. | UNINA-9910778790003321 |
| Washington, D.C. : , : National Academy Press, , 1989 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
| ||
Controlling costs and changing patient care? : the role of utilization management / / Committee on Utilization Management by Third Parties, Division of Health Care Services, Institute of Medicine ; Bradford H. Gray and Marilyn J. Field, editors
| Controlling costs and changing patient care? : the role of utilization management / / Committee on Utilization Management by Third Parties, Division of Health Care Services, Institute of Medicine ; Bradford H. Gray and Marilyn J. Field, editors |
| Edizione | [1st ed.] |
| Pubbl/distr/stampa | Washington, D.C., : National Academy Press, 1989 |
| Descrizione fisica | 1 online resource (viii, 312 pages) : illustrations |
| Disciplina | 338.4/33621/0973 |
| Altri autori (Persone) |
GrayBradford H. <1942->
FieldMarilyn J (Marilyn Jane) |
| Soggetto topico |
Cost control
Health services administration - United States |
| ISBN |
1-280-21445-7
9786610214457 0-309-54309-6 0-585-14457-5 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Nota di contenuto |
Controlling Costs and Changing Patient Care? -- Copyright -- Contents -- Preface -- Executive Summary -- CURRENT STATUS OF UTILIZATION MANAGEMENT -- HOW UTILIZATION MANAGEMENT IS EVOLVING -- ISSUES FOR THE FUTURE -- RECOMMENDATIONS FOR THE NEAR TERM -- Responsibilities of Employers and Purchasers -- Responsibilities of Utilization Management Organizations -- Responsibilities of Practitioners and Institutions -- Responsibilities of Patients -- LONGER-TERM RECOMMENDATIONS AND QUESTIONS -- Research On Effectiveness -- Practice Guidelines and Review Criteria -- Oversight of Utilization Management -- 1 Utilization Management: Introduction and Definitions -- WHAT IS UTILIZATION MANAGEMENT? -- Prior Review -- High-Cost Case Management -- Retrospective Utilization Review -- Other Cost-Containment Methods -- TWO NOTES OF CAUTION -- Obstacles To Evaluation -- Intrinsic Conceptual and Methodological Problems -- Common Behavioral Biases Against Evaluation -- Competition and Evaluation -- Forces Behind Rising Health Care Costs -- REFERENCES -- 2 Origins of Utilization Management -- THE GROWTH OF THIRD-PARTY FINANCING OF HEALTH CARE -- EARLY COST-MANAGEMENT EFFORTS BY THIRD PARTIES -- Management of the Risk Pool -- Design of the Benefit Plan -- Controls On Payments To Providers -- Constraints On Supply -- Utilization Review -- GOVERNMENT AND EMPLOYER INVOLVEMENT -- Federal Government Initiatives -- Private Purchasers Become an Force -- OTHER FACTORS GIVING RISE TO UTILIZATION MANAGEMENT -- Inappropriate Utilization as an Cost-Containment Target -- Variations in Utilization -- Inappropriate Utilization -- Linking Cost and Quality -- Improving the Tools and Structures for Utilization Management -- Information Resources -- Assessment and Education Strategies -- New Organizations -- CONCLUSION -- REFERENCES.
3 The Utilization Management Industry: Structure and Process -- INDUSTRY OVERVIEW -- THE REALITIES OF PRIOR REVIEW: HOW IS IT ACTUALLY DONE? -- How Prior Review Is Integrated with Other Administrative Functions -- How Basic Logistical Matters Are Handled -- Initiating Review -- Handling Telephone Calls -- Computerization -- How Nurse Reviewers Work -- What Role Do Physician Advisers Play? -- What Style Is Used with Attending Physicians? -- What Criteria Are Used to Assess Care? -- Lists of Procedures -- Exceptions Criteria -- Hospitalization Criteria -- Length-Of-Stay Norms -- Necessity of a Procedure -- How Criteria Are Adopted and Modified -- How Organizations Use Criteria -- Appeals Processes -- Reporting and Feedback Mechanisms -- SECOND-OPINION REQUIREMENTS -- LEGAL ISSUES -- CONCLUSION -- REFERENCES -- 4 Impact of Prior Review Programs -- DIRECTION OF AVAILABLE EVIDENCE: IMPACT ON UTILIZATION AND COST -- Before-and-After Studies -- Comparative Studies -- Multivariate Studies -- Impact of Second-Opinion Programs -- WEAKNESSES IN THE EVIDENCE ON EFFECTS OF PRIOR REVIEW -- EFFECTS OF PRIOR REVIEW ON SPECIFIC PARTIES -- Effects on Enrollees and Patients -- Quality of Care -- Navigating Health Care and Health Benefits -- Patient Costs, Comfort, and Convenience -- Effects on Health Care Practitioners and Institutions -- Physician-Patient Relationship -- Physician-Hospital Relations -- Provider-Purchaser Relations -- Effects of Prior Review on Purchasers -- CONCLUSION -- APPENDIX SOME METHODOLOGICAL ISSUES IN ASSESSING THE EFFECTS OF UTILIZATION MANAGEMENT PROGRAMS -- Claims Data -- Group Data -- Program Data -- Savings Calculations -- Other Interventions -- Medical Care Prices -- Noneconomic effects -- REFERENCES -- 5 High-Cost Case Management -- FOCUS OF HIGH-COST CASE MANAGEMENT -- ROLE OF THE PURCHASER -- HOW HIGH-COST CASE MANAGEMENT WORKS. Operational Variations -- How Cases Are Identified and Screened -- Who Serves as Case Manager? -- How Case Managers Relate to Patients and Providers -- How Much Case Management Costs -- IMPACT OF HIGH-COST CASE MANAGEMENT -- EFFECTS OF HIGH-COST CASE MANAGEMENT ON SPECIFIC PARTIES -- Effects on Enrollees -- Effects on Health Care Providers -- Effects on Purchasers -- QUESTIONS ABOUT AVAILABLE EVIDENCE -- LEARNING CURVE IN HIGH-COST CASE MANAGEMENT -- POTENTIAL LEGAL ISSUES -- CONCLUSION -- REFERENCES -- 6 Conclusions and Recommendations -- CURRENT STATUS OF UTILIZATION MANAGEMENT -- HOW UTILIZATION MANAGEMENT IS EVOLVING -- Scope of Review -- Operational Efficiency -- Rationing -- ISSUES FOR THE FUTURE -- RECOMMENDATIONS FOR THE NEAR TERM -- Responsibilities of Employers and Purchasers -- Responsibilities of Utilization Management Organizations -- Responsibilities of Health Care Practitioners and Institutions -- Responsibilities of Patients -- RECOMMENDATIONS AND QUESTIONS FOR THE LONGER TERM -- Research on Effectiveness -- Practice Guidelines and Review Criteria -- Oversight of Utilization Management -- CONCLUSION -- Acknowledgments -- Appendixes -- Appendix A Legal Implications of Utilization Review -- Introduction -- The Types of Utilization Review -- The Sarchett Decision -- The Wickline Decision -- The Elusive Concept of Medical Necessity -- Liability of the Review Organization -- Negligence -- Existence of an Duty of Care -- The Standard of Care -- Causation -- Breach of Contract -- Insurance Bad Faith -- Infliction of Emotional Distress -- Warranty Theories -- Products Liability -- Defamation and Interference with Contractual Advantage -- Antitrust -- Liability of Consultants and Employees -- State Regulation -- Erisa Preemption -- Liability of the Employer or Payer -- Direct Liability -- Vicarious Liability -- Indemnity. Liability of the Treating Physician -- Legal Issues For the Patient -- The Need For Expedited Review -- Payment For Unnecessary Medical Services -- Conclusion -- References -- Appendix B Utilization Management and Quality Assurance in Health Maintenance Organizations: an Operational Assessment -- Methodology -- Hmo Organizational Structure -- Market, Structural, and Operational Factors Affecting Hmo Performance -- The Health Care Marketplace -- Hmo Structure -- Hmo Operations -- Approaches to Utilization Management and Quality Assurance -- Underwriting Benefits -- Delivery of Health Services -- Quality Assurance -- Operational Problems Impairing Utilization Management and Quality Assurance Programs -- Utilization Management Programs -- Quality Assurance -- Design and Use of Physician Incentives -- Background -- Current Surveys Concerning Physician Incentives -- Administering Physician Incentives -- Policy and Research Issues -- Case Studies Introduction -- Case Study 1: Hospital-Sponsored Ipa -- Background -- Control Type -- Financial Incentives -- Design of Mis System -- Utilization Management -- Medical Director and Utilization Management Support Staff -- Case Study 2: Group-Model Hmo -- Background -- Control Type -- Financial Incentives -- Design of Mis System -- Utilization Management -- Medical Director and Utilization Management Support Staff -- Case Study 3: Carrier-Sponsored Hmo -- Background -- Control Type -- Financial Incentives -- Design of Mis System -- Utilization Management -- Medical Director and Utilization Management Support Staff -- Case Study 4: Carrier-Sponsored Hmo -- Background -- Control Type -- Financial Incentives -- Design of Mis System -- Utilization Management and Support Staff -- Medical Director and Utilization Management Support Staff -- Case Study 5: Physician-Sponsored Ipa -- Background -- Control Type. Financial Incentives -- Design of Mis System -- Utilization Management -- Ipa Management -- Notes and References -- Appendix C Utilization Management in Peer Review Organizations -- References -- Appendix D Summary of Public Hearings -- Appendix E Summaries of Committee Site Visits To Utilization Management Organizations -- Organization 1 -- Organization 2 -- Organization 3 -- Organization 4 -- Organization 5 -- Organization 6 -- Organization 7 -- Organization 8 -- Organization 9 -- Organization 10 -- Organization 11 -- Organization 12 -- Appendix F Analysis of Agreements Between Utilization Management Organizations and Their Clients -- Contractual Descriptions of Prior Review Services -- Sources of Clinical Criteria and Standards -- Distinction Between the Review Determination and Purchaser's Decision To Pay For Services -- Indemnification and Liability Insurance Coverage -- Staffing and Performance Criteria -- Proprietary Information and Competition -- Appendix G Glossary and Acronyms -- Glossary -- Acronyms -- Appendix H Biographies of Committee Members -- Index. |
| Record Nr. | UNINA-9910828354403321 |
| Washington, D.C., : National Academy Press, 1989 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
| ||
For-profit enterprise in health care [[electronic resource] /] / Committee on Implications of For-Profit Enterprise in Health Care, Institute of Medicine ; Bradford H. Gray, editor
| For-profit enterprise in health care [[electronic resource] /] / Committee on Implications of For-Profit Enterprise in Health Care, Institute of Medicine ; Bradford H. Gray, editor |
| Pubbl/distr/stampa | Washington, D.C., : National Academy Press, 1986 |
| Descrizione fisica | 1 online resource (580 p.) |
| Disciplina | 362.1/1/0681 |
| Altri autori (Persone) | GrayBradford H. <1942-> |
| Soggetto topico |
Medical economics
Health facilities, Proprietary Medical corporations |
| Soggetto genere / forma | Electronic books. |
| ISBN |
1-280-22166-6
9786610221660 0-309-55763-1 0-585-14411-7 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Nota di contenuto |
For-Profit Enterprise in Health Care; Copyright; Contents; ACKNOWLEDGMENTS; INTRODUCTION TO THE VOLUME; ORIGINS OF THIS INQUIRY; FOCUS OF THIS STUDY; THE COMPLICATIONS OF CHANGE; SOURCES OF INFORMATION; THE PRODUCTS OF THIS INQUIRY; CONCLUSION; PART I COMMITTEE REPORT ; 1 Profits and Health Care: An Introduction to the Issues ; QUESTIONS EXAMINED IN THIS REPORT; THE DIVERSE OWNERSHIP OF AMERICAN HEALTH CARE ORGANIZATIONS; THE FOR-PROFIT/NOT-FOR-PROFIT DISTINCTION; Investor Ownership; Not-For-Profit Organizations; Problems with the For-Profit/Not-For-Profit Distinction; THE VALUE QUESTION
Health Care as Economic Good Health Care as Social Good; Economic Good Versus Social Good; Relationship of Physicians to Health Care Organizations; NOTES; References; APPENDIX TO CHAPTER 1; Economic Rationale for the Three Sectors; Models of the Behavior of For-Profit and Not-For-Profit Organizations; Why For-Profit Hospitals May be Inefficient; Notes; 2 Changes in the Ownership, Control, and Configuration of Health Care Services ; HOSPITALS; Investor-Owned Hospital Systems; Not-For-Profit Hospital Systems; COMPARISONS OF INVESTOR-OWNED AND NOT-FOR-PROFIT SYSTEMS; Psychiatric Hospitals NURSING HOMES HEALTH MAINTENANCE ORGANIZATIONS; HOME CARE; NEW TYPES OF PROVIDERS; Freestanding Primary Care Centers; Other Services; VERTICAL INTEGRATION AND DIVERSIFICATION; FOR-PROFIT/NOT-FOR-PROFIT HYBRIDS; CONCLUSIONS; NOTES; References; 3 Financial Capital and Health Care Growth Trends ; WHAT IS CAPITAL?; SOURCES OF CAPITAL FUNDS FOR HEALTH CARE PROVIDERS; Trends in Sources of Financial Capital; Relationship of Ownership to Sources of Capital; THE COSTS OF CAPITAL; Philanthropy and Governmental Grants; Debt Financing; Equity Financing; THE LEVEL PLAYING FIELD ARGUMENT POLICY ISSUES REGARDING CAPITAL CONCLUSION; NOTES; References; APPENDIX TO CHAPTER 3; Note; 4 Investor Ownership and the Costs of Medical Care ; DEFINITION AND MEASUREMENT OF COSTS-AND WHO IS CONCERNED; STUDIES OF HOSPITAL EXPENSE AND PRICING; Expenses; Prices; MARKUP; PROFITABILITY; COSTS AND ACQUISITION OF HOSPITALS; NURSING HOME COSTS; OTHER FOR-PROFIT PROVIDERS; MONITORING COST TRENDS; CONCLUSIONS; NOTES; References; 5 Access to Care and Investor-Owned Providers ; THE PROBLEM OF CARE FOR THOSE UNABLE TO PAY; The Financing of Uncompensated Care; THE PROVIDERS OF UNCOMPENSATED CARE; OCR DATA AHA Data State Data; REDUCING UNCOMPENSATED CARE; The Impact of For-Profit Acquisition; Cross-Subsidies and Uncompensated Care; Other For-Profit Providers; Types of Services in Various Hospitals; Which Hospital Services Lose Money?; For-Profit/Not-For-Profit Differences in Services; Cross-Subsidies and Uncompensated Care; ACCESS TO NURSING HOMES; ISSUES AND RECOMMENDATIONS; The Measurement of Care to Patients Unable to Pay; The Need for Better Information; The Obligations of Health Care Institutions; The Issue of Tax Status; The Government's Obligation for Uninsured Patients; CONCLUSION; NOTES References |
| Record Nr. | UNINA-9910455761303321 |
| Washington, D.C., : National Academy Press, 1986 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
| ||
For-profit enterprise in health care / / Committee on Implications of For-Profit Enterprise in Health Care, Institute of Medicine ; Bradford H. Gray, editor
| For-profit enterprise in health care / / Committee on Implications of For-Profit Enterprise in Health Care, Institute of Medicine ; Bradford H. Gray, editor |
| Pubbl/distr/stampa | Washington, D.C. : , : National Academy Press, , 1986 |
| Descrizione fisica | 1 online resource (580 pages) |
| Disciplina | 362.1/1/0681 |
| Altri autori (Persone) | GrayBradford H. <1942-> |
| Soggetto topico |
Medical economics
Health facilities, Proprietary Medical corporations |
| ISBN |
1-280-22166-6
9786610221660 0-309-55763-1 0-585-14411-7 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Nota di contenuto |
For-Profit Enterprise in Health Care; Copyright; Contents; ACKNOWLEDGMENTS; INTRODUCTION TO THE VOLUME; ORIGINS OF THIS INQUIRY; FOCUS OF THIS STUDY; THE COMPLICATIONS OF CHANGE; SOURCES OF INFORMATION; THE PRODUCTS OF THIS INQUIRY; CONCLUSION; PART I COMMITTEE REPORT ; 1 Profits and Health Care: An Introduction to the Issues ; QUESTIONS EXAMINED IN THIS REPORT; THE DIVERSE OWNERSHIP OF AMERICAN HEALTH CARE ORGANIZATIONS; THE FOR-PROFIT/NOT-FOR-PROFIT DISTINCTION; Investor Ownership; Not-For-Profit Organizations; Problems with the For-Profit/Not-For-Profit Distinction; THE VALUE QUESTION
Health Care as Economic Good Health Care as Social Good; Economic Good Versus Social Good; Relationship of Physicians to Health Care Organizations; NOTES; References; APPENDIX TO CHAPTER 1; Economic Rationale for the Three Sectors; Models of the Behavior of For-Profit and Not-For-Profit Organizations; Why For-Profit Hospitals May be Inefficient; Notes; 2 Changes in the Ownership, Control, and Configuration of Health Care Services ; HOSPITALS; Investor-Owned Hospital Systems; Not-For-Profit Hospital Systems; COMPARISONS OF INVESTOR-OWNED AND NOT-FOR-PROFIT SYSTEMS; Psychiatric Hospitals NURSING HOMES HEALTH MAINTENANCE ORGANIZATIONS; HOME CARE; NEW TYPES OF PROVIDERS; Freestanding Primary Care Centers; Other Services; VERTICAL INTEGRATION AND DIVERSIFICATION; FOR-PROFIT/NOT-FOR-PROFIT HYBRIDS; CONCLUSIONS; NOTES; References; 3 Financial Capital and Health Care Growth Trends ; WHAT IS CAPITAL?; SOURCES OF CAPITAL FUNDS FOR HEALTH CARE PROVIDERS; Trends in Sources of Financial Capital; Relationship of Ownership to Sources of Capital; THE COSTS OF CAPITAL; Philanthropy and Governmental Grants; Debt Financing; Equity Financing; THE LEVEL PLAYING FIELD ARGUMENT POLICY ISSUES REGARDING CAPITAL CONCLUSION; NOTES; References; APPENDIX TO CHAPTER 3; Note; 4 Investor Ownership and the Costs of Medical Care ; DEFINITION AND MEASUREMENT OF COSTS-AND WHO IS CONCERNED; STUDIES OF HOSPITAL EXPENSE AND PRICING; Expenses; Prices; MARKUP; PROFITABILITY; COSTS AND ACQUISITION OF HOSPITALS; NURSING HOME COSTS; OTHER FOR-PROFIT PROVIDERS; MONITORING COST TRENDS; CONCLUSIONS; NOTES; References; 5 Access to Care and Investor-Owned Providers ; THE PROBLEM OF CARE FOR THOSE UNABLE TO PAY; The Financing of Uncompensated Care; THE PROVIDERS OF UNCOMPENSATED CARE; OCR DATA AHA Data State Data; REDUCING UNCOMPENSATED CARE; The Impact of For-Profit Acquisition; Cross-Subsidies and Uncompensated Care; Other For-Profit Providers; Types of Services in Various Hospitals; Which Hospital Services Lose Money?; For-Profit/Not-For-Profit Differences in Services; Cross-Subsidies and Uncompensated Care; ACCESS TO NURSING HOMES; ISSUES AND RECOMMENDATIONS; The Measurement of Care to Patients Unable to Pay; The Need for Better Information; The Obligations of Health Care Institutions; The Issue of Tax Status; The Government's Obligation for Uninsured Patients; CONCLUSION; NOTES References |
| Record Nr. | UNINA-9910778675303321 |
| Washington, D.C. : , : National Academy Press, , 1986 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
| ||
For-profit enterprise in health care / / Committee on Implications of For-Profit Enterprise in Health Care, Institute of Medicine ; Bradford H. Gray, editor
| For-profit enterprise in health care / / Committee on Implications of For-Profit Enterprise in Health Care, Institute of Medicine ; Bradford H. Gray, editor |
| Edizione | [1st ed.] |
| Pubbl/distr/stampa | Washington, D.C., : National Academy Press, 1986 |
| Descrizione fisica | 1 online resource (580 pages) |
| Disciplina | 362.1/1/0681 |
| Altri autori (Persone) | GrayBradford H. <1942-> |
| Soggetto topico |
Medical economics
Health facilities, Proprietary Medical corporations |
| ISBN |
1-280-22166-6
9786610221660 0-309-55763-1 0-585-14411-7 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Nota di contenuto |
For-Profit Enterprise in Health Care; Copyright; Contents; ACKNOWLEDGMENTS; INTRODUCTION TO THE VOLUME; ORIGINS OF THIS INQUIRY; FOCUS OF THIS STUDY; THE COMPLICATIONS OF CHANGE; SOURCES OF INFORMATION; THE PRODUCTS OF THIS INQUIRY; CONCLUSION; PART I COMMITTEE REPORT ; 1 Profits and Health Care: An Introduction to the Issues ; QUESTIONS EXAMINED IN THIS REPORT; THE DIVERSE OWNERSHIP OF AMERICAN HEALTH CARE ORGANIZATIONS; THE FOR-PROFIT/NOT-FOR-PROFIT DISTINCTION; Investor Ownership; Not-For-Profit Organizations; Problems with the For-Profit/Not-For-Profit Distinction; THE VALUE QUESTION
Health Care as Economic Good Health Care as Social Good; Economic Good Versus Social Good; Relationship of Physicians to Health Care Organizations; NOTES; References; APPENDIX TO CHAPTER 1; Economic Rationale for the Three Sectors; Models of the Behavior of For-Profit and Not-For-Profit Organizations; Why For-Profit Hospitals May be Inefficient; Notes; 2 Changes in the Ownership, Control, and Configuration of Health Care Services ; HOSPITALS; Investor-Owned Hospital Systems; Not-For-Profit Hospital Systems; COMPARISONS OF INVESTOR-OWNED AND NOT-FOR-PROFIT SYSTEMS; Psychiatric Hospitals NURSING HOMES HEALTH MAINTENANCE ORGANIZATIONS; HOME CARE; NEW TYPES OF PROVIDERS; Freestanding Primary Care Centers; Other Services; VERTICAL INTEGRATION AND DIVERSIFICATION; FOR-PROFIT/NOT-FOR-PROFIT HYBRIDS; CONCLUSIONS; NOTES; References; 3 Financial Capital and Health Care Growth Trends ; WHAT IS CAPITAL?; SOURCES OF CAPITAL FUNDS FOR HEALTH CARE PROVIDERS; Trends in Sources of Financial Capital; Relationship of Ownership to Sources of Capital; THE COSTS OF CAPITAL; Philanthropy and Governmental Grants; Debt Financing; Equity Financing; THE LEVEL PLAYING FIELD ARGUMENT POLICY ISSUES REGARDING CAPITAL CONCLUSION; NOTES; References; APPENDIX TO CHAPTER 3; Note; 4 Investor Ownership and the Costs of Medical Care ; DEFINITION AND MEASUREMENT OF COSTS-AND WHO IS CONCERNED; STUDIES OF HOSPITAL EXPENSE AND PRICING; Expenses; Prices; MARKUP; PROFITABILITY; COSTS AND ACQUISITION OF HOSPITALS; NURSING HOME COSTS; OTHER FOR-PROFIT PROVIDERS; MONITORING COST TRENDS; CONCLUSIONS; NOTES; References; 5 Access to Care and Investor-Owned Providers ; THE PROBLEM OF CARE FOR THOSE UNABLE TO PAY; The Financing of Uncompensated Care; THE PROVIDERS OF UNCOMPENSATED CARE; OCR DATA AHA Data State Data; REDUCING UNCOMPENSATED CARE; The Impact of For-Profit Acquisition; Cross-Subsidies and Uncompensated Care; Other For-Profit Providers; Types of Services in Various Hospitals; Which Hospital Services Lose Money?; For-Profit/Not-For-Profit Differences in Services; Cross-Subsidies and Uncompensated Care; ACCESS TO NURSING HOMES; ISSUES AND RECOMMENDATIONS; The Measurement of Care to Patients Unable to Pay; The Need for Better Information; The Obligations of Health Care Institutions; The Issue of Tax Status; The Government's Obligation for Uninsured Patients; CONCLUSION; NOTES References |
| Record Nr. | UNINA-9910819275003321 |
| Washington, D.C., : National Academy Press, 1986 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
| ||
The new health care for profit [[electronic resource] ] : doctors and hospitals in a competitive environment / / edited by Bradford H. Gray (Institute of Medicine)
| The new health care for profit [[electronic resource] ] : doctors and hospitals in a competitive environment / / edited by Bradford H. Gray (Institute of Medicine) |
| Pubbl/distr/stampa | Washington, D.C., : National Academy Press, c1983 |
| Descrizione fisica | 1 online resource (186 p.) |
| Disciplina | 362.1/1/0973 |
| Altri autori (Persone) | GrayBradford H. <1942-> |
| Soggetto topico |
Health facilities, Proprietary - United States
Medical corporations - United States |
| Soggetto genere / forma | Electronic books. |
| ISBN |
1-280-24585-9
9786610245857 0-309-53383-X 0-585-15567-4 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Record Nr. | UNINA-9910455413303321 |
| Washington, D.C., : National Academy Press, c1983 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
| ||
The new health care for profit : doctors and hospitals in a competitive environment / / edited by Bradford H. Gray (Institute of Medicine)
| The new health care for profit : doctors and hospitals in a competitive environment / / edited by Bradford H. Gray (Institute of Medicine) |
| Pubbl/distr/stampa | Washington, D.C. : , : National Academy Press, , 1983 |
| Descrizione fisica | 1 online resource (viii, 178 pages) |
| Disciplina | 362.1/1/0973 |
| Altri autori (Persone) | GrayBradford H. <1942-> |
| Soggetto topico |
Health facilities, Proprietary - United States
Medical corporations - United States |
| ISBN |
1-280-24585-9
9786610245857 0-309-53383-X 0-585-15567-4 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Record Nr. | UNINA-9910778889803321 |
| Washington, D.C. : , : National Academy Press, , 1983 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
| ||
The new health care for profit : doctors and hospitals in a competitive environment / / edited by Bradford H. Gray (Institute of Medicine)
| The new health care for profit : doctors and hospitals in a competitive environment / / edited by Bradford H. Gray (Institute of Medicine) |
| Edizione | [1st ed.] |
| Pubbl/distr/stampa | Washington, D.C., : National Academy Press, c1983 |
| Descrizione fisica | 1 online resource (viii, 178 pages) |
| Disciplina | 362.1/1/0973 |
| Altri autori (Persone) | GrayBradford H. <1942-> |
| Soggetto topico |
Health facilities, Proprietary - United States
Medical corporations - United States |
| ISBN |
1-280-24585-9
9786610245857 0-309-53383-X 0-585-15567-4 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Nota di contenuto |
The New Health Care for Profit -- Copyright -- Preface -- Contents -- An Introduction to the New Health Care for Profit -- THE CHANGING HEALTH CARE ENVIRONMENT -- PROFESSIONAL AUTONOMY, TRUST, AND HEALTH POLICY -- IMPLICATIONS OF THE CURRENT CHANGES IN FOR-PROFIT HEALTH CARE -- THE INSTITUTE OF MEDICINE PROJECT -- CONCLUSION -- REFERENCES AND NOTES -- Legal Differences Between Investor-Owned and Nonprofit Health Care Institutions -- ORGANIZATIONAL DIFFERENCES -- Investor-Owned Hospitals -- Nonprofit Hospitals -- FINANCIAL DIFFERENCES -- Tax Exemptions -- Reimbursement Factors -- Sources of Capital -- Restrictions On Transfers of Property -- OTHER LEGAL DIFFERENCES -- CONCLUSION -- REFERENCES AND NOTES -- Wall Street and the For-Profit Hospital Management Companies -- ANALYSTS' SOURCES OF INFORMATION -- FINANCIAL ANALYSES OF COMPANIES -- THE IMPORTANCE OF STOCK PRICES TO THE COMPANIES -- REASONS FOR SUCCESS OF THE HOSPITAL MANAGEMENT COMPANIES -- DIFFERENCES AMONG COMPANIES -- ACQUISITIONS -- MAKING HOSPITALS HEALTHIER -- OUTLOOK FOR THE FUTURE -- REFERENCES AND NOTES -- When Investor-Owned Corporations Buy Hospitals: Some Issues and Concerns -- THE FIVE CASES -- County Hospital A -- County Hospital B -- Doctors Hospital -- Osteopathic Hospital -- Suburban County Hospital -- MAJOR ISSUES -- Control -- Job Security and Benefits -- Plant and Equipment -- Charges for Care -- Quality of Care -- Admission Policies -- Buy-Back Provision -- THE PROCESS -- CONCLUSIONS -- Appendix Principal Interviews Conducted for This Paper -- Physician Involvement in Hospital Decision Making -- A TYPOLOGY OF HOSPITAL DECISION MAKING -- CONVERGENCE VERSUS DIVERGENCE OF INTERESTS -- THE DECISION MAKERS -- The Dual Authority Model -- The Shared Authority Model -- STRAIN AMONG DECISION MAKERS AND BETWEEN THE TWO MODELS -- TYPES OF PHYSICIAN DECISION-MAKING INVOLVEMENT.
HOSPITAL/PHYSICIAN DECISION MAKING AND THE COST AND QUALITY OF CARE -- Evidence Regarding Costs -- Evidence Regarding Quality -- Evidence Regarding Possible Trade-Offs Between Cost and Quality -- FUTURE ISSUES -- The Changing Context of Clinical Decision Making -- The Changing Context of Institutional Decision Making -- The Demise of the Voluntary Medical Staff -- Factors Promoting or Impeding Shared Decision-Making Models -- SUMMARY -- REFERENCES AND NOTES -- Economic Incentives and Clinical Decisions -- MODELS OF CLINICAL DECISION MAKING -- INCENTIVES FROM THE PERSPECTIVE OF THE PHYSICIAN AND THE ECONOMIST -- Incentives and the Use of Technology -- Payment and Practice Setting Incentives -- Individual versus Collective Patterns of Practice -- SUMMARY AND CONCLUSIONS -- REFERENCES -- Ethical Dilemmas of For-Profit Enterprise in Health Care -- HISTORY OF THE ETHICS CONTROVERSY -- The International Context -- The American Medical Association -- Advertising -- Patents -- Dispensing Pharmaceuticals and Receiving Rebates -- Fee Splitting -- Ownership of Health Facilities and Corporate Relations -- A SUMMARY OF THE PROFESSIONAL PHYSICIAN STANCE -- Basic Principles of the Professional Stance -- Service to the Patient -- Physician Control of Decision Making and Fees -- Acceptance of Profit Motive -- Suspicion of Commercialization -- An Interpretation of the Professional Stance -- PHYSICIANS COMPARED WITH OTHER PROFESSIONALS -- A PHILOSOPHICAL EVALUATION OF THE PROBLEM -- Problems with Evaluations Based on Professional Codes -- Basic Philosophical Themes -- Business Ethics and Physician Ethics: The Role of Altruism -- Deontological versus Consequentialist Ethics -- Health Care as a Commodity -- The Double Agent Problem -- Differences Between Business and Physician Ethics -- Lying and Deception -- Competitor's Use of Outdated Information. Enticement of Customers into Needless Consumption -- Exclusion of Inefficient Customers -- The Duty to the Indigent -- Supplying Unprofitable Products and Services -- Differing Concepts of Self-Regulation -- CONCLUSION -- REFERENCES AND NOTES -- Secondary Income From Recommended Treatment: Should Fiduciary Principles Constrain Physician Behavior? -- THE PHYSICIAN-PATIENT CONFLICT OF INTEREST PROBLEM -- BACKGROUND OF FIDUCIARY LAW -- FIDUCIARY THEORY IN MEDICAL LITIGATION -- Physician As Guardian of Patient Property -- Kickback Cases -- Reimbursement Cases -- Girl and Contract Cases -- Physician As Advisor -- Confidentiality Cases -- Statute of Limitations Cases -- Informed Consent Cases -- Physician as Agent -- CONCLUSION -- REFERENCES AND NOTES -- Biographical Sketches of Contributors -- Index. |
| Record Nr. | UNINA-9910812031203321 |
| Washington, D.C., : National Academy Press, c1983 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
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