Industry and Hmos: A Natural Alliance

ISBN-13: 9780387903668 / Angielski / Miękka / 1978 / 117 str.

Richard H. Egdahl; Diana C. Walsh

Opis

This fifth issue in the Industry and Health Care series takes a quick turn through unpredictable and only partially charted waters. The series as a whole has set out to explore the role of industry as a potential agent of change in the health care system, and to map the courses that may lead toward control of costs. One that looks possible is the effort now being made to infuse some competition into the health care industry through organized systems of care, known as HMOs. Health maintenance organizations, especially the fee-for-service variety known as IPAs (individual practice associations), have been a particular inter- est of the Center for Industry and Health Care, where a national data base 'on IP A performance is being established with the aid of the Robert Wood Johnson Foundation. The Center's identity with HMOs, combined with its focus on industry and health care, has afforded us unusual access to nascent corporate thinking on the pros and cons of HMO sponsorship. We are grateful for these opportunities, and for the insights industry people have shared with us. This series draws heavily on that experience.

Spis treści

1. What Can Industry Do for HMOs and HMOs for Industry?.- HMOs and Health Care Costs.- Industry and HMOs.- Notes.- 2. Defining Corporate Strategies and Goals.- Organizational Patterns and Beginning Steps.- Savings Potential in an HMO: The First Cut and a Second Look.- Data Deficiencies: Approximations and Proxies.- The Current Benefit Package and Management—Labor Relations.- The Physician—Patient Relationship and the Tightrope of Medical Politics.- Geography: Concentration and Clout.- The “Bottom Line” Is the Bottom Line….- …Or Is It?.- Notes.- 3. Identifying Available Options.- Salaried Group HMOs: Roots in Prepaid Group Practices.- Fee-for-Service HMOs.- Other Emerging HMO Models.- Potential Partners for HMO Development.- Notes.- 4. Assessing Legal Obstacles.- Liability Issues for the HMO.- Corporate Liability.- State Law.- ERISA.- Antitrust Law.- Conclusion.- Notes.- 5. Issues for the Future.- The Issues for Industry: Setting Realistic Expectations and Goals.- The Issues for HMOs: Amassing Useful Data and Establishing Credible Records.- The Broader Policy Issue: Who Ought to Realize the Savings?.- Notes.- Appendix I A National Call to Action: Secretary Califano’s HMO Conference.- Appendix II Bay State Health Care Foundation Hearings.- Appendix III Panel Discussion: Should Industry Sponsor Fee-for-Service HMOs?.