Mental health articles

managed care Synonyms
Integrated health care delivery; Coordination of care
managed care definition in health care
There is no generally admitted definition of Managed
Care. The term Managed Care refers to a variety of
structural and procedural issues that had a major impact on the US health insurance system and health care
structures and that were at least partly adopted by other
health care systems in the aftermath. The principle
of Managed Care is to manage and integrate the
whole range of services that a patient needs with the
theoretical aim of maximizing efficiency and effectiveness
of health care delivery. A characteristic of Managed
Care models is that the provider of health insurance
steers and monitors the delivery of the respective
health care services to a higher degree than usual.
The strict separation between medical responsibility
on the one hand and financing and administration on
the other hand moves towards an integrated, cross-functional
approach. Managed Care systems typically rely on a primary care physician who acts as a gatekeeper through whom the patient has to go to obtain other health services such as specialty medical care, surgery, or physical therapy.
The following elements summarize the key characteristics
of Managed Care models:
• Diligent selection of the participating/approved
health care providers (selective contracting)
• Limitation of utilization of health care services to
selected providers, partially with a primary care
physician assigned as “gatekeeper” and responsible
for the overall care of members assigned to him/her
• Setting of financial incentives for the health care provider and insured person
• Development and review of  treatment guidelines
• Ex ante evaluation of necessity and adequacy of specific services/procedures (e. g.  preadmission reviews)
• Retrospective review in case of specific predefined
incidents
•  Cost-effectiveness analysis of new technologies

Tags: care, Health, health care, managed care