Managed Care Health Insurance

Why do people buy health insurance? Conventional theory holds that people purchase insurance because they prefer the certainty of paying a small premium to the risk of getting sick and paying a large medical bill. Conventional theory also holds that any additional health care that people purchase when they are insured is of such low value that it is not worth the costs of providing it. As a result, economists have promoted policies, such as cost sharing and managed care, to reduce consumption of this "low-value" care. This book presents a new theory of consumer demand for heath insurance. It holds that people purchase insurance to obtain additional "income" when they become ill. In effect, insurance companies take the premiums paid by those who remain relatively healthy and transfer them to those who come down with a serious disease. This additional income often allows sick persons to obtain medical care that they may not otherwise be able to afford. The value of health insurance, therefore, stems largely from the value of the additional health care that insurance makes possible, and has little, if anything, to do with preferences for certainty. Because its value lies largely in providing access to necessary health care, health insurance is held to be much more valuable under the new theory than the old. The new theory also implies that cost sharing and managed care -- central health policies of the last 30 years -- were largely directed at solving problems that did not exist. Because these policies either reduced the "income" transferred to ill persons or limited access to additional health care, they may have done more harm than good. The new theory suggests that insurancecoverage should be extended to the uninsured. It also provides a solid theoretical justification for implementing some form of national health insurance. The new theory emphasizes three constraints.

Today, more than 11 million American children lack health insurance and the number increases every year. America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? Topics explored include: -- The changing role of Medicaid under managed care. -- State-initiated and private sector children's insurance programs. -- Specific effects of insurance status on the care children receive. -- The impact of chronic medical conditions and special health care needs. -- The status of "safety net" health providers: community health centers, children's hospitals, school-based health centers, and others. -- Private-sector, employer-based health insurance: the changing patterns of coverage and tax policy options to increase coverage.

Health maintenance organization - A Health Maintenance Organization (HMO) is a type of Managed Care Organization (MCO) that provides a form of health insurance coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. Unlike traditional indemnity insurance, care provided in an HMO generally follows a set of care guidelines provided through the HMO's network of providers.

Preferred provider organization - In health insurance, a preferred provider organization (or "PPO") is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.

Social health insurance - Broadly speaking, health care systems across the world are funded in three different ways: by private contributions, social health insurance contributions or taxes. Social health insurance systems are characterized by the presence of sickness funds which usually receive a proportional contribution of their members' wages.

Coventry Health Care, Inc. - Coventry Health Care, Inc. (Coventry) () is a managed health care company in the United States.

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Managed Care Health Insurance - Managed Care Health Insurance Managing Managed Care File claims that get paid Get more sessions for your clients Take the stress out of communicating with managed-care companies Promote your clients’ Confidentiality Learn to take charge of managed care A"how-to" guide for dealing with the everyday practice issues related to working with managed care. Written by an industry insider, Managing Managed Care offers a candid managed care health insurance and unprecedented behind-the-scenes view, with focus on issues ...

Managed Health Care - Managed Health Care The Strategic Application of Information Technology in Health Care Organizations Information technology is a critical factor in the success of strategic planning for health care organizations. If health care organizations are to thrive in the highly competitive health care marketplace, they must invest in managed health care and develop their information technology (IT) capabilities. This thoroughly revised managed health care and updated second edition ofThe Strategic Application of Information Technology in Health Care Organizations offers health care executives ...

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