Managed Care

managed health care

managed health care, system of health-care delivery that aims to control costs by assigning set fees for services, monitoring the need for procedures such as tests and surgical operations, and stressing preventive care. Managed health-care systems include health maintenance organizations; preferred provider organizations (PPOs), networks of doctors and hospitals that adhere to given guidelines and fees in return for receiving a certain number of patients; and point of service (POS) plans, which are similar to PPOs but allow patients to go outside the network for treatment, usually at a higher cost. The term is also used to describe more traditional health-insurance plans that require that more expensive procedures be reviewed and approved by a plan official before they are performed. In managed care, the doctor is often paid a set fee or is paid a set amount monthly for each patient, a scheme called capitation. Many physicians criticize managed care systems, saying that they take away their freedom to make treatment decisions, that they are motivated mainly by economics, and that they do not consider patients as individuals. Managed health-care systems also limit doctors' incomes and what many people consider to be the abuses of the older fee-for-service system that rewarded doctors financially for doing more procedures. See also health insurance.

The Columbia Encyclopedia, 6th ed. Copyright© 2014, The Columbia University Press.

Selected full-text books and articles on this topic

Managed Care: Made in America
Arnold Birenbaum.
Praeger, 1997
The Managed Care Blues and How to Cure Them
Walter A. Zelman; Robert A. Berenson.
Georgetown University Press, 1998
Ethical Challenges in Managed Care: A Casebook
Karen Grandstrand Gervais; Reinhard Priester; Dorothy E. Vawter; Kimberly K. Otte; Mary M. Solberg.
Georgetown University Press, 1999
Managed Care and the Evaluation and Adoption of Emerging Medical Technologies
Steven Garber; M. Susan Ridgely; Roger Taylor; Robin Main.
Rand, 2000
The Economic Evolution of American Health Care: From Marcus Welby to Managed Care
David Dranove.
Princeton University Press, 2000
The Unraveling of Managed Care: Recent Trends and Implications
Gorin, Stephen H.
Health and Social Work, Vol. 28, No. 3, August 2003
PEER-REVIEWED PERIODICAL
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
Regulating Managed Care: Theory, Practice, and Future Options
Stuart H. Altman; Uwe E. Reinhardt; David Shactman.
Jossey-Bass, 1999
Disability and Managed Care: Problems and Opportunities at the End of the Century
Arnold Birenbaum.
Praeger, 1999
Back to the Future: The Managed Care Revolution
Agrawal, Gail B.; Veit, Howard R.
Law and Contemporary Problems, Vol. 65, No. 4, Autumn 2002
The Quality of Managed Care: Evidence from the Medical Literature
Gottfried, Joseph; Sloan, Frank A.
Law and Contemporary Problems, Vol. 65, No. 4, Autumn 2002
Managed Care and the Evolving Role of the Clinical Social Worker in Mental Health
Cohen, Jeffrey A.
Social Work, Vol. 48, No. 1, January 2003
PEER-REVIEWED PERIODICAL
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
Managed Care and the Judicial System: Another Avenue for Reform?
Lens, Vicki.
Health and Social Work, Vol. 27, No. 1, February 2002
PEER-REVIEWED PERIODICAL
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
Market Failures and the Evolution of State Regulation of Managed Care
Sloan, Frank A.; Hall, Mark A.
Law and Contemporary Problems, Vol. 65, No. 4, Autumn 2002
Dealing Constructively with Managed Care: Suggestions from an Insider
Anderson, Christopher E.
Journal of Mental Health Counseling, Vol. 22, No. 4, October 2000
PEER-REVIEWED PERIODICAL
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
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