Many physicians will be sued for malpractice at some time during their careers. Risk of litigation can be reduced by adopting practices that include keeping thorough medical records, educating office personnel, and fo...
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Many physicians will be sued for malpractice at some time during their careers. Risk of litigation can be reduced by adopting practices that include keeping thorough medical records, educating office personnel, and fostering good patient-physician relationships. The last is important because patients who view their physicians as caring tend not to sue even if an adverse outcome occurs.
In 1994, the Agency for Health Care Policy and Research awarded cooperative agreements to five University-based groups to promote the establishment of managed care Institutions and development of rural health networks...
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In 1994, the Agency for Health Care Policy and Research awarded cooperative agreements to five University-based groups to promote the establishment of managed care Institutions and development of rural health networks. This paper summarizes the experiences of these rural managed care centers in the first three years of this initiative. Key ingredients for achieving the project's goals that are identified by the project directors are reported as "foundations" that must be in place from the outset, or "building blocks" that can be developed along the way. The development of information systems and efforts to foster leadership in the medical community are areas in which grant funding of this type can be most effective.
This article introduces the Fort Bragg managed care experiment. This study was a 5-year, $80 million effort to evaluate the cost-effectiveness of a full continuum of mental health services for children and adolescents...
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This article introduces the Fort Bragg managed care experiment. This study was a 5-year, $80 million effort to evaluate the cost-effectiveness of a full continuum of mental health services for children and adolescents. The article describes the development of the Demonstration, the program theory underlying intervention, and how this theory was tested.
A stratified, random sample of 80 providers in the Massachusetts Medicaid Managed Mental Health/Substance Abuse Program were interviewed by phone to assess their views of the program in year four. Providers continued ...
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A stratified, random sample of 80 providers in the Massachusetts Medicaid Managed Mental Health/Substance Abuse Program were interviewed by phone to assess their views of the program in year four. Providers continued to believe that access and quality were the same or better than a year earlier, that client severity continued to increase while length of stay decreased, that readmissions and emergency room admissions were the same as a year earlier, and that aftercare was the same or better than a year earlier. Substantial problems were reported in the integration of services, in linkages with support services, and with administration of the program.
The speed and ubiquity oft he move from fee-for-service to managed care raises questions about how these changes affect children. This article examines (1) the pace and context of the move to managed care for children...
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The speed and ubiquity oft he move from fee-for-service to managed care raises questions about how these changes affect children. This article examines (1) the pace and context of the move to managed care for children, (2) potential opportunities and challenges emerging from these changes, (3) research findings on how managed care affects children, and (4) next steps for learning more. The research review provides a consistent answer to whether managed care is good for children: if depends on what kind of managed care, which children, and under what circumstances. This finding suggests lessons for future research: (I)focus on particular features of managed care, (2) get inside the "black box" of managed care and examine providers, (3) expand the portfolio of research on children: research on adults cannot "trickle down" to children, (4)foster research partnerships and networks, and (5) focus on poor and chronically ill children.
In urban areas, employers are frequently in the forefront of efforts to implement managed care initiatives at the community level, either individually or through coalitions. While employer-driven managed care initiati...
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In urban areas, employers are frequently in the forefront of efforts to implement managed care initiatives at the community level, either individually or through coalitions. While employer-driven managed care initiatives also exist in rural areas, they are less common and much less is known about them. This article describes and analyzes the early experience of a large rural employer-the state of South Dakota-in its attempt to develop and implement a managed care initiative. Several aspects of that experience suggest that employer-driven managed care models in urban sites may require reexamination and redefinition for implementation in rural areas.
Arnold Relman argues that medical education does not prepare students and residents to practice their profession in today's corporate health care system. Corporate health care administrators agree: Physicians ente...
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Arnold Relman argues that medical education does not prepare students and residents to practice their profession in today's corporate health care system. Corporate health care administrators agree: Physicians enter the workforce unskilled in contract negotiation, evidence-based medicine, navigating bureaucratic systems, and so forth. What about practicing physicians? Do they agree as well? According to this study, they do. Feeling like decentered double agents and unprepared, physicians find themselves professionally lost, struggling to balance issues of cost and care and expressing lots of negativity toward the cultures of medicine and managed care. However, physicians are resilient. A group of physicians, who may be called proactive, are meeting the professional demands of corporate health care by becoming sophisticated about its bureaucratic organization and the ways in which their professional and personal commitments fit within the system. Following the lead of proactive physicians, the auf hors support Relman's thesis that education for both students and physicians requires a major overhaul.
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