Medicaid and managed care

Article Abstract:

The shifting of Medicaid patients into managed care programs is underway but is not without problems. Pres Clinton and the Republican-controlled Congress both support this process in an effort to bring Medicaid spending under control. Congress may give states block grants and allow local governments to administer the programs. Several states have already enrolled their Medicaid patients into managed care programs, including Arizona, Florida, Tennessee, California and New York. Arizona's successful 12-year program has cut medical and administrative cost by 7%. The shift has caused problems in some states, where doctors have resigned from plans and traditional Medicaid providers believe they will lose badly needed revenues. However, many of the patients have access to better care than they did under Medicaid. In June, 1994, 7.8 million Medicaid patients had been enrolled in a managed care plan, and most are single-parent families.

Health aspects, Management, Innovations, Poor, Medicaid

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Revisiting the Canadian health care system

Article Abstract:

Canada has a publicly funded health care system that provides universal coverage for all Canadians. Canada also forbids any private insurance company to pay for services that are publicly funded. This was done partly to prevent insurance companies from insuring only low-risk patients and to prevent the formation of a two-tiered health care system. However, in 1997, the government reduced funding for health care. This created longer waiting times, restricted access to specialists, and the closure or merging of many hospitals. Many Canadians would support a two-tiered system if it would improve access to care.

Canada, Health care industry

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The National Committee for Quality Assurance

Article Abstract:

The National Committee for Quality Assurance (NCQA) is slowly gaining credibility among providers and purchasers of health care. The NCQA was created in 1979 by the managed care industry but became independent in 1990. Its major purpose is to accredit managed care plans. To do this it compares the plan's performance with the data set organized by the Health Plan Employer Data and Information Set (HEDIS). Many large employers will only deal with accredited plans and the managed care plans themselves seek accreditation so they can compete for contracts.

Standards, Medical care, Quality management, Medical care quality, National Committee for Quality Assurance

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