FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1539528091> ?p ?o ?g. }

• W1539528091 endingPage "103" @default.
• W1539528091 startingPage "103" @default.
• W1539528091 abstract "I INTRODUCTION The past decade has seen a proliferation of state laws aimed at modifying the function of managed care organizations (MCOs). (1) Reaction to the increasing prevalence and novel practices of MCOs has prompted passage of hundreds of state statutes governing everything from direct access to medical specialists, to minimum coverage standards for maternity stays. (2) The federal government has also taken action on such matters, and the competing patients' bills of rights under consideration in Congress would all expand federal oversight of managed care activities. (3) Though the true impetus for these legal initiatives is debatable, the proponents of measures often cite concern over the quality--or safety--of managed care as the driving force behind their legislative efforts. (4) Critics contend that MCOs sacrifice high-quality health care for cost savings and provide inferior medical coverage compared to fee-for-service (FFS) plans. (5) Horror stories about alleged abuse or neglect of p atients by MCOs have gained wide circulation. (6) There are even web sites devoted to the promulgation of such anecdotal evidence. (7) Opponents of managed care have employed these singular tales of terror to advance their legislative agendas. (8) This article examines the empirical evidence, drawn from the medical literature, pertaining to the safety of managed care practices. It seeks to ground the ongoing debate on the medical merits of MCOs in the science of clinical research. The article is divided into three major sections. Part II is a systematic review of recent literature on the overall quality of MCOs relative to FFS plans, focusing on clinically important outcome and process measures. It extends previous such analyses to the present day. Part III surveys articles comparing the performance of generalists and specialists in the latter's fields of expertise. It aims to weigh claims about the alleged risks of gatekeeping, a traditional feature of managed care that has come under increasing criticism. Part IV analyzes the medical evidence on early postpartum discharge (drive-through deliveries), perhaps the most publicized example of the supposed dangers of managed care. Though originating in FFS settings, this practice is associated with MCO s due to their widespread adoption of short maternal stays. Finally, the article renders an evidence-based opinion on the quality of America's major form of private health care coverage. II QUALITY-OF-CARE PERFORMANCE: MANAGED CARE VERSUS FEE-FOR-SERVICE Considerable data on the quality of care in MCOs versus FFS does exist even though it is conspicuously absent from public debates on the safety of managed care and the need for more patient protection laws in the post-FFS era. Robert Miller and Harold Luft have reviewed much of the early research on this subject, and in 1994 published the first of two literature analyses on the topic. (9) Examining studies from 1980 through 1993, the investigators found that MCO members were more likely than FFS plan enrollees to receive recommended preventive health services. (10) They also reported that treatment processes and outcomes for a wide range of medical conditions were roughly comparable between the two types of coverage. In 1997, the authors completed a second narrative review on the subject. (11) Considering studies published since their previous analysis, they concluded that available evidence suggested essentially equivalent quality of care between MCOs and FFS plans. (12) They cautioned, however, that almost none of the papers in their review included primary data past 1992, when cost cutting by MCOs began in earnest. (13) In a recent examination of Miller and Luft's methods, Kip Sullivan criticized their analyses for failing to control for differences in the level of coverage between insurance plans. …" @default.
• W1539528091 created "2016-06-24" @default.
• W1539528091 creator A5008242590 @default.
• W1539528091 creator A5056900579 @default.
• W1539528091 date "2002-01-01" @default.
• W1539528091 modified "2023-09-25" @default.
• W1539528091 title "The Quality of Managed Care: Evidence from the Medical Literature" @default.
• W1539528091 doi "https://doi.org/10.2307/1192281" @default.
• W1539528091 hasPublicationYear "2002" @default.
• W1539528091 type Work @default.
• W1539528091 sameAs 1539528091 @default.
• W1539528091 citedByCount "1" @default.
• W1539528091 countsByYear W15395280912017 @default.
• W1539528091 crossrefType "journal-article" @default.
• W1539528091 hasAuthorship W1539528091A5008242590 @default.
• W1539528091 hasAuthorship W1539528091A5056900579 @default.
• W1539528091 hasBestOaLocation W15395280912 @default.
• W1539528091 hasConcept C111472728 @default.
• W1539528091 hasConcept C138885662 @default.
• W1539528091 hasConcept C144133560 @default.
• W1539528091 hasConcept C160735492 @default.
• W1539528091 hasConcept C162118730 @default.
• W1539528091 hasConcept C17744445 @default.
• W1539528091 hasConcept C199539241 @default.
• W1539528091 hasConcept C2779473830 @default.
• W1539528091 hasConcept C2779530757 @default.
• W1539528091 hasConcept C2780265253 @default.
• W1539528091 hasConcept C3018989441 @default.
• W1539528091 hasConcept C71924100 @default.
• W1539528091 hasConceptScore W1539528091C111472728 @default.
• W1539528091 hasConceptScore W1539528091C138885662 @default.
• W1539528091 hasConceptScore W1539528091C144133560 @default.
• W1539528091 hasConceptScore W1539528091C160735492 @default.
• W1539528091 hasConceptScore W1539528091C162118730 @default.
• W1539528091 hasConceptScore W1539528091C17744445 @default.
• W1539528091 hasConceptScore W1539528091C199539241 @default.
• W1539528091 hasConceptScore W1539528091C2779473830 @default.
• W1539528091 hasConceptScore W1539528091C2779530757 @default.
• W1539528091 hasConceptScore W1539528091C2780265253 @default.
• W1539528091 hasConceptScore W1539528091C3018989441 @default.
• W1539528091 hasConceptScore W1539528091C71924100 @default.
• W1539528091 hasIssue "4" @default.
• W1539528091 hasLocation W15395280911 @default.
• W1539528091 hasLocation W15395280912 @default.
• W1539528091 hasOpenAccess W1539528091 @default.
• W1539528091 hasPrimaryLocation W15395280911 @default.
• W1539528091 hasRelatedWork W1728623977 @default.
• W1539528091 hasRelatedWork W2002875279 @default.
• W1539528091 hasRelatedWork W2125990337 @default.
• W1539528091 hasRelatedWork W2152517245 @default.
• W1539528091 hasRelatedWork W2402515989 @default.
• W1539528091 hasRelatedWork W2543326689 @default.
• W1539528091 hasRelatedWork W2569401834 @default.
• W1539528091 hasRelatedWork W2770332404 @default.
• W1539528091 hasRelatedWork W4247431809 @default.
• W1539528091 hasRelatedWork W592034735 @default.
• W1539528091 hasVolume "65" @default.
• W1539528091 isParatext "false" @default.
• W1539528091 isRetracted "false" @default.
• W1539528091 magId "1539528091" @default.
• W1539528091 workType "article" @default.