Traduction en anglais : Managed care.
Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market.
The initial effects consisted ofa decrease in insurance premiums, a very attractive feature for employers.
Managed care promises to contain expenditures for health care.
Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too.
In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined.
The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians : the physician must act as a « double agent », caring for the interest for the individual patient and being restricted by the contract with the managed care organisation.
Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients).
Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations.
The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular.
The paradigm of managed care, i.e. (...)
Mots-clés Pascal : Soin intégré, Service santé, Allemagne, Europe, Coût, Qualité, Economie santé, Homme
Mots-clés Pascal anglais : Managed care, Health service, Germany, Europe, Costs, Quality, Health economy, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0393985
Code Inist : 002B30A01B. Création : 25/01/1999.