Managed Care

PEDIATRICS ◽  
1992 ◽  
Vol 90 (2) ◽  
pp. 278-279
Author(s):  
JENIFER D. C. CARTLAND ◽  
BETH K. YUDKOWSKY
Keyword(s):  
Managed Care ◽  
Medical Care ◽  
Care Program ◽  
Kaiser Permanente ◽  
Care Plans

In Reply.— Doctors Sapin and Laws raise fundamental concerns about our article that was recently published in Pediatrics.1 We feel that these concerns are addressed adequately in the paper, but we would like to take this opportunity to clarify our findings. Dr Sapin argues that our study characterizes all managed care plans, such as the Kaiser Permanente Medical Care Program in which he practices, as having ineffective referral mechanisms. He holds that pediatricians at Kaiser experience "no barriers to appropriate referrals" and indicates that we did not stress this finding adequately.

Measuring the Return on Government Spending on the Medicare Managed Care Program

2011 ◽  
Vol 11 (2) ◽  
Author(s):  
Anne E Hall
Keyword(s):  
Managed Care ◽  
Government Spending ◽  
Logit Model ◽  
Care Program ◽  
Research Literature ◽  
Nested Logit ◽  
Detailed Data ◽  
Nested Logit Model ◽  
Care Plans

Abstract I estimate the welfare provided to beneficiaries by the Medicare managed care program, and its net costs, for the years 1999-2002. I measure beneficiary welfare with a nested logit model of demand for Medicare HMO plans using detailed data on plan benefits. From this, I find that total beneficiary welfare provided by the program over the four-year period is about $61 billion (2000 $). I also use data on and estimates of the favorable selection enjoyed by Medicare HMOs from the research literature to estimate net costs of the program, which range from $21 billion to $31 billion (2000 $). Estimated net beneficiary welfare of the program therefore ranges from $30 billion to $40 billion and the estimated return on government spending ranges from 96 percent to 186 percent. Even though managed care plans are overpaid by Medicare, the program still enjoys a substantial return due to the popularity of its offerings.

Liberal Default, Labor Support, and Conservative Neutrality: The Kaiser Permanente Medical Care Program After World War II

1989 ◽  
Vol 1 (2) ◽  
pp. 156-180 ◽  
Author(s):  
Rickey L. Hendricks
Keyword(s):  
World War Ii ◽  
Health Insurance ◽  
Private Sector ◽  
Medical Care ◽  
National Health Insurance ◽  
National Health ◽  
Care Program ◽  
The Political ◽  
World War ◽  
Kaiser Permanente

In the politically turbulent post–World War II period, proposed federal legislation to expand the welfare state pitted conservative Republicans against liberal Democrats in Congress. The conflict over national health insurance introduced between 1943 and 1947 in the Wagner-Murray- Dingell bill ended in a conservative victory with the bill stalled in committee. The primary constituents of the two sides were American Medical Association (AMA) spokesmen and corporate interests on the political right and labor leaders and public health advocates on the left. By 1946 the conservatives controlled Congress; thereafter liberal congressional reformers defaulted on the national health issue, as they had throughout the twentieth century, to corporate progressives and the tenets of “welfare capitalism.” Government continued as a regulator of “minimum standards” for business and industry. Provision of voluntary health insurance and direct medical services was left to the private sector. The Kaiser Permanente Medical Care Program emerged out of the political stalemate over health care in the middle 1940s as a highly efficient and popular prepaid group health plan, innovative in its large scale and total integration of service and facilities. Its survival and growth was due to its acceptability to both liberals and conservatives as a model private-sector alternative to national health insurance or any other form of state medicine.

COPD and Incident Cardiovascular Disease Hospitalizations and Mortality: Kaiser Permanente Medical Care Program

CHEST Journal ◽  
2005 ◽  
Vol 128 (4) ◽  
pp. 2068-2075 ◽  
Author(s):  
Stephen Sidney ◽  
Michael Sorel ◽  
Charles P. Quesenberry ◽  
Cynthia DeLuise ◽  
Stephan Lanes ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Medical Care ◽  
Care Program ◽  
Kaiser Permanente ◽  
Incident Cardiovascular Disease

scholarly journals Commercial managed care plans leaving the Medicaid Managed Care Program in New York State: Impact on quality and access

2000 ◽  
Vol 77 (4) ◽  
pp. 560-572 ◽  
Author(s):  
Patrick J. Roohan ◽  
Mary Beth Conroy ◽  
Joseph P. Anarella ◽  
Jacqueline M. Butch ◽  
Foster C. Gesten
Keyword(s):  
New York ◽  
Managed Care ◽  
New York State ◽  
Care Program ◽  
Medicaid Managed Care ◽  
York State ◽  
Care Plans

The Impact of Aids on the Kaiser Permanente Medical Care Program: Office of Technology Assessment

1989 ◽  
Vol 5 (1) ◽  
pp. 151-153
Keyword(s):  
Medical Care ◽  
Technology Assessment ◽  
Lifetime Cost ◽  
Care Program ◽  
Cost Of Care ◽  
Average Lifetime ◽  
Northern California ◽  
Kaiser Permanente ◽  
Office Of Technology Assessment ◽  
The Impact

The average lifetime cost of care for AIDS patients in the Kaiser Permanente Northern California (KPNCE) is $35,054, according to a study released today by the Congressional Office of Technology Assessment (OTA).The study was prepared for OTA by KPNCR, part of the Kaiser Permanente Medical Care Program, the nation's largest prepaid group practice health plan. KPNCR provides medical and hospital services to more than 2 million people in northern California-25% of the area's population.

Abstract P187: Blood Pressure Control in Adults with Autistic Spectrum Disorders in a Large Integrated Medical Care Program is Better Than in a Demographically Matched Comparison Group

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Stephen Sidney ◽  
Ousseny Zerbo ◽  
Michael E Sorel ◽  
Yinge Qian ◽  
Steve Rich ◽  
...  
Keyword(s):  
Medical Care ◽  
Care Program ◽  
Pressure Control ◽  
Autism Spectrum ◽  
Kaiser Permanente ◽  
Comparable Group ◽  
Integrated Medical Care ◽  
Spectrum Disorders ◽  
Matched Comparison ◽  
Adults With Asd

Background: The prevalence of autism spectrum disorders (ASD) has been increasing, with a recent CDC estimate of 1 of 68 children. As this cohort ages, millions of individuals will advance into adulthood with this diagnosis. A recent report from Kaiser Permanente Northern California (KPNC), an integrated medical care program serving about 3.5 million members, showed that adults with ASD have a higher prevalence of hypertension (HTN), than a comparable group not known to have ASD (non-ASD). We are unaware of data regarding HTN control in persons with ASD. Hypothesis: HTN control rates will be lower in ASD than in non-ASD KPNC members because of communication difficulties associated with ASD. Methods: We identified 1,507 KPNC members, age >18 years, with ASD (ICD-9-CM codes 299.0, 299.8. 299.9) during the time period, 1/1/2008-12/31/2012, of which 218 had HTN (2 outpatient diagnoses of HTN, or 1 outpatient diagnosis of HTN with a prescription for anti-hypertensive medication within 12 months of HTN identification). For each ASD patient, we identified 5 comparison KPNC non-ASD members with HTN, matched for age, sex, race, and year of HTN identification (n=1,090). We determined all primary care outpatient blood pressures (BP) recorded within 12 months after HTN identification and used the final BP obtained for analysis. We excluded 14 members with no BPs (1 ASD, 13 controls) and 39 members, age >65 years (8 ASD, 31 controls). HTN control was defined as systolic BP <140 and diastolic BP <90 mm Hg. BP control rates were age-adjusted using weighting derived from the 2000 U.S. census. Results: The mean age was 43.6 years for ASD and 43.9 for controls (p=0.74). The HTN control rate was higher for ASD (84.2%; age-adjusted 84.9%) than for controls (73.5%, age-adjusted 71.7%) (p=0.001). Members with ASD had more BP measurements (mean 6.0, standard deviation [s.d.] 6.2) than controls (mean 4.8, s.d. 4.4) (p=0.0008). Conclusion: HTN was better controlled in adults with ASD than in non-ASD adults, possibly related to more frequent measurement of BP.

PEDIATRICS AND ECONOMICS

PEDIATRICS ◽  
1948 ◽  
Vol 2 (1) ◽  
pp. 89-96
Author(s):  
WARREN R. SISSON
Keyword(s):  
Medical Care ◽  
Care Program ◽  
The State ◽  
Medical Services ◽  
Non Profit ◽  
Care Plans ◽  
Department Of Health ◽  
Recent Estimate ◽  
The Many ◽  
Blue Shield

WHETHER we like it or not, we must admit that we are living and working in a period of basic changes in the economic aspects of the practice of medicine. There was a day when the physician could make his visits on a completely individual basis and charge as much for his services as he considered appropriate. His bills were entirely between himself and his patients. But today an increasing number of physicians are finding themselves participants in one or another of the many medical care plans which are spreading rapidly throughout the country. A great variety of plans are being developed by public welfare agencies, health departments, non-profit organizations, medical societies, unions, cooperatives and other groups. Under the provisions of these plans the physician must abide by certain regulations directly affecting his practice and the fees he is entitled to collect. The growth of the Blue Shield plans for voluntary medical care insurance has been phenomenal and is now so rapid that it is impossible to state accurately from day to day the number of their subscribers. A recent estimate indicates that there are 48 plans with more than 7,000,000 subscribers. In fact Blue Shield seems to be on the way to catching up with Blue Cross, which now has some 30,000,000 subscribers. Other plans are testing different methods of providing service. One of the most notable of these is the Maryland Medical Care Program, which was established by legislation in 1945 providing that the State Department of Health should administer a program of medical services for indigent and medically indigent persons. Under the provisions of this plan county health officers have assumed administrative responsibility for this program of medical services; physicians are paid directly by the State Treasurer in accordance with a fixed fee schedule.

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