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  1. Managed care : US research evidence and its lessons for the NHS.

    Article - En anglais


    To review the high quality US evidence on performance of managed health care organisations and the available US evidence on specific managed care techniques ; namely, financial incentives, utilisation management and review, physician profiling and disease management.


    Literature searches were conducted using numerous databases including Medline, Embase, the Social Sciences Citation Index and the National Health Service (NHS) Centre for Reviews and Dissemination library.

    For inclusion of evaluations of overall performance, studies had to use a comparison group (typically fee-for-service patients), make appropriate statistical adjustments for differences between groups, and be published in a peer-reviewed journal from 1980 forward.

    For assessments of techniques, less-demanding inclusion criteria reflected the paucity of generalisable literature ; however, more current results were required (1990 forward).


    We identified 70 articles for systematic review, covering 18 dimensions of performance (e.g. utilisation, quality of care, consumer satisfaction, equity).

    The strength of the evidence varied by dimension.

    It was strongest for utilisation and quality.

    In general, managed care seems to reduce hospitalisation and use of high-cost discretionary services, to increase preventive screening, and to be neutral in terms of patient outcomes. (...)

    Mots-clés Pascal : Etats Unis, Amérique du nord, Amérique, Monde, Royaume Uni, Europe, Hospitalisation, Hôpital, Soin, Dépistage, Prévention, Ethique, Economie, Bibliographie, Réseau, Soin intégré, Aspect politique, Géographie, Grande Bretagne, Europe Ouest, Santé, Politique sanitaire, Qualité, Satisfaction, Utilisateur, Coût, Maladie, Economie santé

    Mots-clés Pascal anglais : United States, North America, America, World, United Kingdom, Europe, Hospitalization, Hospital, Care, Medical screening, Prevention, Ethics, Economy, Bibliography, Network, Managed care, Political aspect, Geography, Great Britain, Western Europe, Health, Health policy, Quality, Satisfaction, User, Costs, Disease, Health economy

    Logo du centre Notice produite par :
    Observatoire Régional de la Santé Auvergne-Rhône-Alpes

    Code Inist : 002B30A11. Création : 19/02/1999.