Biomaterial Database

Medicaid managed care: contribution to issues of health reform. 1995

D A Freund, and R E Hurley

School of Public and Environmental Affairs, Indiana University, Indianapolis 46202, USA.

This chapter examines the emergence of managed care in Medicaid from an alternative to the mainstream delivery system for many beneficiaries. It offers a definition that encompasses the broad spectrum of program manifestations, and presents a brief historical perspective on the major eras of managed care in Medicaid. The major program prototypes are described and their contribution to enrollment growth is discussed. Research evidence is examined to address both operational issues and program impacts. Finally, we conclude with an appraisal of contemporary issues of importance and speculation on the next generation of Medicaid managed care programs with an eye to how federal and state health care reform proposals will shape this future.

UI	MeSH Term	Description	Entries
D008329	Managed Care Programs	Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.	Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D008484	Medicaid	Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.	Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D011785	Quality Assurance, Health Care	Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.	Quality Assessment, Health Care,Health Care Quality Assessment,Health Care Quality Assurance,Healthcare Quality Assessment,Healthcare Quality Assurance,Quality Assessment, Healthcare,Quality Assurance, Healthcare,Assessment, Healthcare Quality,Assessments, Healthcare Quality,Assurance, Healthcare Quality,Assurances, Healthcare Quality,Healthcare Quality Assessments,Healthcare Quality Assurances,Quality Assessments, Healthcare,Quality Assurances, Healthcare
D013221	State Health Plans	State plans prepared by the State Health Planning and Development Agencies which are made up from plans submitted by the Health Systems Agencies and subject to review and revision by the Statewide Health Coordinating Council.	Comprehensive Health Plans, State,Health Plan, State,Health Plans, State,Plan, State Health,Plans, State Health,State Health Plan
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D017146	Models, Organizational	Theoretical representations and constructs that describe or explain the structure and hierarchy of relationships and interactions within or between formal organizational entities or informal social groups.	Organizational Models,Model, Organizational,Organizational Model
D018166	Health Care Reform	Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.	Healthcare Reform,Health Care Reforms,Healthcare Reforms,Reform, Health Care,Reform, Healthcare,Reforms, Health Care,Reforms, Healthcare