The reconfiguration of US medicine

Article Abstract:

Price competition is changing the way health care services are delivered and paid. For-profit managed care networks and employer self-insured plans are dominating private insurance health care. Managed care plans use selective contracting to choose providers who have track records of keeping costs down. The plans curb expenditures and set limits on services covered. Ninety-five percent of insured employees are now covered by managed care plans, which include HMOs and preferred provider organizations. Large hospitals, large hospitals, large physician groups, and large insurance companies are securing the lucrative contracts for medical care, causing the smaller providers to drop out or merge. The U.S. government has joined the effort by attempting to toe the line on its Medicaid and Medicare programs. This fundamental transformation is the result of sharp-rising health care costs since the 1970s, a weakened economy, and budget deficits.

Usage, Finance, Health insurance, Managed care plans (Medical care)

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Mechanisms for controlling costs

Article Abstract:

Medical care cost controls should achieve their objective without compromising health outcome. Cost control measures limit the flow of money from payers to health insurers or from health insurers to medical providers. Government regulation or managed competition may control the flow of money from payers to health insurers. Managed competition shifts a portion of health insurance premiums from employers to employees, which is most detrimental to people with low incomes. Price controls and quantity controls limit the flow of money from health insurers to medical providers. Utilization management that targets physicians' practice patterns, supply limits that control the number of physicians and resources, and patient cost sharing also control the flow of money from health insurers to providers. Managed care programs use an array of cost control measures.

Management, Medical care, Cost of, Health care costs

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Electronic technology: a spark to revitalize primary care?

Article Abstract:

The advantages and disadvantages of electronic health care are reviewed. Topics include medical records, communication, knowledge base and decision support, time and expense, Web site quality, incompatible software programs, patient privacy, lack of reimbursement, the physician-patient relationship, prescribing, reminder systems, physician feedback, and self-management of chronic diseases.

Evaluation, Technology application, Medical informatics, Medical offices

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