Public Hospitals and Managed Care

Managed health care is used increasingly in the public and private sectors to control rising health-care costs and to assure quality of care. While current proposals for health-care reform promote even wider application of managed care as a component in cost control, the formal use of managed care by public hospitals has not been fully explored. This article identifies possible reasons for providing managed care within a public-hospital system, explores the implications of managed care for public hospitals and their patients, and addresses some of the barriers to implementing managed care in a traditional public-hospital setting.

[1]  P. Orris,et al.  Effect of racial and socioeconomic factors on asthma mortality in Chicago. , 1992, Chest.

[2]  E. Friedman.  Problems plaguing public hospitals: uninsured patient transfers, tight funds, mismanagement, and misperception. , 1987, JAMA.

[3]  E. Legome.  Socioeconomic inequalities in health: No easy solution , 1994 .

[4]  A M Epstein,et al.  Case mix and resource utilization by uninsured hospital patients in the Boston metropolitan area. , 1989, JAMA.

[5]  D. Freund,et al.  Gatekeeping the emergency department: Impact of a Medicaid primary care case management program , 1989, Health care management review.

[6]  E. Friedman.  Public hospitals often face unmet capital needs, underfunding, uncompensated patient-care costs. , 1987, JAMA.

[7]  P. J. Arnold,et al.  The impact of health care financing on childhood immunization practices. , 1992, American journal of diseases of children.

[8]  K. Ringen,et al.  Health policy: gaps in access, delivery, and utilization of the Pap smear in the United States. , 1987, Milbank Quarterly.

[9]  L. Haywood.  Hypertension in minority populations. Access to care. , 1990, The American journal of medicine.

[10]  D. Nutter.  Medical indigency and the public health care crisis. The need for a definitive solution. , 1987, The New England journal of medicine.

[11]  A M Epstein,et al.  The emergency department as a pathway to admission for poor and high-cost patients. , 1991, JAMA.

[12]  L. Rossiter,et al.  Coordinated care and public programs. , 1991, Health affairs.

[13]  G. Melnick,et al.  Uncompensated emergency care in hospital markets in Los Angeles County. , 1989, American journal of public health.

[14]  D. Patrick,et al.  Health status and use of services among families with and without health insurance. , 1992, Medical care.

[15]  T. Carey,et al.  Diagnostic testing and return visits for acute problems in prepaid, case-managed Medicaid plans compared with fee-for-service. , 1990, Archives of internal medicine.

[16]  S. Folkman,et al.  Socioeconomic inequalities in health. No easy solution. , 1993 .

[17]  P. Newacheck,et al.  Health insurance status of young adults in the United States. , 1989, Pediatrics.

[18]  J. Iglehart,et al.  The American health care system. Managed care. , 1992, The New England journal of medicine.

[19]  C Gatsonis,et al.  Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. , 1992, JAMA.

[20]  A M Epstein,et al.  Delayed access to health care: risk factors, reasons, and consequences. , 1991, Annals of internal medicine.

[21]  A. Hillman,et al.  An academic medical center's experience with mandatory managed care for Medicaid recipients , 1991, Academic medicine : journal of the Association of American Medical Colleges.

[22]  D. Freund,et al.  Rollover effects in gatekeeper programs: cushioning the impact of restricted choice. , 1991, Inquiry : a journal of medical care organization, provision and financing.

[23]  N. Goldfield.  Measurement and management of quality in managed care organizations: alive and improving. , 1991, QRB. Quality review bulletin.

[24]  J. Kasper.  The Importance of Type of Usual Source of Care for Children's Physician Access and Expenditures , 1987, Medical care.

[25]  C. Hafner-Eaton,et al.  Physician utilization disparities between the uninsured and insured. Comparisons of the chronically ill, acutely ill, and well nonelderly populations. , 1993, JAMA.

[26]  M. Rivo,et al.  Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986. , 1990, International journal of epidemiology.

[27]  H. Temkin-Greener,et al.  Medicaid beneficiaries under managed care: provider choice and satisfaction. , 1991, Health services research.

[28]  A. Epstein,et al.  Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. , 1989, JAMA.

[29]  D. Andrulis,et al.  Our nation's great public hospitals. , 1987, JAMA.

[30]  T. Rice,et al.  Change and growth in managed care. , 1991, Health affairs.

[31]  S. Shortell.  A model for state health care reform. , 1992, Health affairs.

[32]  D. Freund,et al.  A Typology of Medicaid Managed Care , 1988, Medical care.

[33]  E. Friedman.  Public hospitals: doing what everyone wants done but few others wish to do. , 1987, JAMA.

[34]  A. Hillman,et al.  Impact of a Mandatory Medicaid Case Management Program on Prenatal Care and Birth Outcomes: A Retrospective Analysis , 1991, Medical care.

[35]  T. Rice,et al.  Holes in the Jackson Hole approach to health care reform. , 1993, JAMA.

[36]  R. Lepoff.  Academic medical centers and managed care. , 1995, Archives of pathology & laboratory medicine.

[37]  R. Hoft,et al.  The problems and benefits of associating academic medical centers with health-maintenance organizations. , 1982, The New England journal of medicine.

[38]  C. Sherbourne,et al.  COMPARISON OF HEALTH OUTCOMES AT A HEALTH MAINTENANCE ORGANISATION WITH THOSE OF FEE-FOR-SERVICE CARE , 1986, The Lancet.

[39]  K. Davis.  Inequality and access to health care. , 1991, The Milbank quarterly.

[40]  T. Bennett,et al.  Differences in hospital resource allocation among sick newborns according to insurance coverage. , 1991, JAMA.

[41]  J. Whittle,et al.  Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. , 1993, The New England journal of medicine.

[42]  K. Thorpe,et al.  Improved access to care for the uninsured poor in large cities: do public hospitals make a difference? , 1987, Journal of Health Politics Policy and Law.

[43]  D. Kalmuss,et al.  Barriers to prenatal care among low-income women in New York City. , 1990, Family planning perspectives.

[44]  P. Newacheck,et al.  Childhood asthma and poverty: differential impacts and utilization of health services. , 1993, Pediatrics.

[45]  The Cost of Acute Outpatient Primary Care in a Preferred Provider Organization , 1990, Medical care.

[46]  H. Luft,et al.  How do health-maintenance organizations achieve their "savings"? , 1978, The New England journal of medicine.

[47]  C. Randolph.  IMPACT OF CHILDHOOD ASTHMA ON HEALTH , 1994, Pediatrics.

[48]  Howells Em.  Low-income persons' access to health care: NMCUES Medicaid data. , 1988 .

[49]  M. Fottler,et al.  Determinants of HMO success: the case of Complete Health. , 1992, Health care management review.

[50]  A M Epstein,et al.  The association of payer with utilization of cardiac procedures in Massachusetts. , 1990, JAMA.

[51]  D. Freund,et al.  Emergency room use and primary care case management: evidence from four Medicaid demonstration programs. , 1989, American journal of public health.

[52]  W. D. Greaf.  Public hospital strategic planning: Does it differ from voluntary, not‐for‐profit hospital strategic planning? , 1988, Health care management review.

[53]  L. Manheim,et al.  Access to Office-Based Physicians Under Capitation Reimbursement and Medicaid Case Management: Findings From the Children’s Medicaid Program , 1990, Medical care.

[54]  P. Fox,et al.  Lessons learned from Medicaid managed care approaches. , 1987, Health affairs.

[55]  N. Lewin-Epstein.  Determinants of Regular Source of Health Care in Black, Mexican, Puerto Rican, and Non-Hispanic White Populations , 1991, Medical care.

[56]  A. Enthoven,et al.  Universal health insurance through incentives reform. , 1991, JAMA.

[57]  Hurley Re,et al.  Rollover effects in gatekeeper programs: cushioning the impact of restricted choice. , 1991 .

[58]  W. McClellan,et al.  Race and sex differences in the identification of candidates for renal transplantation. , 1992, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[59]  S A Kupor,et al.  The American Health Care System--Medicare. , 1993, The New England journal of medicine.

[60]  M. Weitzman,et al.  Prior approval in the pediatric emergency room. , 1991, Pediatrics.

[61]  P. Newacheck.  Access to ambulatory care for poor persons. , 1988, Health services research.

[62]  L. Aiken,et al.  Access to medical care for black and white Americans. A matter of continuing concern. , 1989, JAMA.

[63]  M. Bergner,et al.  Treatment Modality and Quality Differences for Black and White Breast-Cancer Patients Treated in Community Hospitals , 1989, Medical care.

[64]  S. H. Long,et al.  An Evaluation of Utah's Primary Care Case Management Program for Medicaid Recipients , 1988, Medical care.

[65]  E. Howell.  Low-income persons' access to health care: NMCUES Medicaid data. , 1988, Public health reports.

[66]  P. Braveman,et al.  Women without health insurance. Links between access, poverty, ethnicity, and health. , 1988, The Western journal of medicine.

[67]  E. Hannan,et al.  Interracial Access to Selected Cardiac Procedures for Patients Hospitalized with Coronary Artery Disease in New York State , 1991, Medical care.

[68]  C. Clancy,et al.  Gatekeeping revisited--protecting patients from overtreatment. , 1992, The New England journal of medicine.

[69]  S. O’Connor,et al.  The end of autonomy? Reflections on the postprofessional physician. , 1992, Health care management review.

[70]  J. Newhouse,et al.  Consumer acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial. , 1986, Health services research.

[71]  L. McBarnette,et al.  Women and Poverty , 1988 .

[72]  W. Manning,et al.  A controlled trial of the effect of a prepaid group practice on use of services. , 1984, The New England journal of medicine.