Biomaterial Database

Managed care and public health departments: who is responsible for the health of the population? 1998

B W Goldberg

Department of Public Health and Preventive Medicine, Oregon Health Sciences University School of Medicine, Portland 97201, USA. goldberg@ohsu.edu

This review examines changes over the past decade in the delivery of health care in the United States, specifically the move toward managed care and capitation. Over 77 million Americans are now enrolled in health maintenance organizations, and the health care delivery system is reorganizing into large group practices and integrated health systems. Examined here are the implications of this shift on the interaction between managed care and public health agencies. How will a population-based system of health care be achieved in light of managed care organizations' responsibility only for their enrolled population, in contrast to the responsibility of the public health service for the entire population? Where does the responsibility of MCOs end and that of public health begin? Should certain public health functions be absorbed by managed care organizations? What are the prospects for partnership between these two systems?

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
D011635	Public Health Administration	Management of public health organizations or agencies.	Administration, Public Health
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012941	Social Responsibility	The obligations and accountability assumed in carrying out actions or ideas on behalf of others.	Obligation, Social,Responsibility, Social,Accountability,Communitarianism,Future Generations,Obligations to Society,Social Accountability,Accountability, Social,Future Generation,Generation, Future,Generations, Future,Obligations, Social,Responsibilities, Social,Social Obligation,Social Obligations,Social Responsibilities,Society, Obligations to
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D018672	Community Health Planning	Planning that has the goals of improving health, improving accessibility to health services, and promoting efficiency in the provision of services and resources on a comprehensive basis for a whole community. (From Facts on File Dictionary of Health Care Management, 1988, p299)	Population-Based Planning,Community Health Systems,Community Health Plannings,Community Health System,Health Planning, Community,Health Plannings, Community,Health System, Community,Health Systems, Community,Planning, Community Health,Planning, Population-Based,Plannings, Community Health,Plannings, Population-Based,Population Based Planning,Population-Based Plannings,System, Community Health,Systems, Community Health