managed care characteristics

managed care characteristics Emergence and Evolution
The health delivery and management forms subsumed
under the term Managed Care originated in the United
States. First attempts can be traced back to the
middle of the 19th century, yet it took until 1973
before Managed Care models gained increasing coverage
when the US Congress enacted The Health Maintenance
Organization Act as a cost-containment strategy.
It offered loan guarantees and start up grants to
encourage the development of alternative delivery systems Managed Care plans, with utilization controls and
preferred provider relationships, became an attractive
alternative to indemnity insurance plans for many
employers. In the 1980s, the Health Care Financing
Administration (HCFA), also under severe pressure to
contain cost increases, began a series of changes in
medicare reimbursement policies. HCFA implemented
revolutionary payment methods that prospectively
paid providers an amount calculated on the basis
of their past delivery of specific diagnosis-related services,
and furthermore several states introduced selective
contracting with health care providers which led
to the emergence of another form of Managed Care,
the Preferred Provider Organizations (PPO). As Managed
Care in the US continued to respond to the changing
market for health care coverage, new relationships
were formed; hospitals merged to create health networks,
physicians were affiliated through joint ventures
with participating hospitals, Managed Care plans
bought health networks to create integrated delivery
systems, and employers joined together and assumed
financial risk to create purchasing coalitions.