Managed Care and Monopoly Power
Managed Care and Monopoly Power

Author: Deborah HAAS-WILSON

Publisher: Harvard University Press

Published: 2009-06-30

Total Pages: 251

ISBN-13: 0674038118

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As millions of Americans are aware, health care costs continue to increase rapidly. Much of this increase in health care costs is due to the development of new life-sustaining drugs and procedures, but part of it is due to the increased monopoly power of physicians, insurance companies, and hospitals, as the health care sector undergoes reorganization and consolidation. There are two tools to limit the growth of monopoly power: government regulation and antitrust policy. In this timely book, Deborah Haas-Wilson argues that enforcement of the antitrust laws is the tool of choice in most cases. Focusing on the economic concepts necessary to the enforcement of the antitrust laws in health care markets, Haas-Wilson provides a useful roadmap for guiding the future of these markets.

Health-Care Utilization as a Proxy in Disability Determination
Health-Care Utilization as a Proxy in Disability Determination

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2018-04-02

Total Pages: 161

ISBN-13: 030946921X

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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Health Insurance and Managed Care
Health Insurance and Managed Care

Author: Peter R. Kongstvedt

Publisher: Jones & Bartlett Learning

Published: 2019-02-14

Total Pages: 355

ISBN-13: 128415209X

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Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.

Managed Care Pharmacy Practice
Managed Care Pharmacy Practice

Author: Navarro

Publisher: Jones & Bartlett Publishers

Published: 2008-12-11

Total Pages: 659

ISBN-13: 076378883X

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Managed Care Pharmacy Practice, Second Edition offers information critical to the development and operation of a managed care pharmacy program. The text also covers the changes that have taken place within the delivery of pharmacy services, as well as the evolving role of pharmacists.

Disentitlement?
Disentitlement?

Author: Timothy Stoltzfus Jost

Publisher: Oxford University Press

Published: 2003-04-10

Total Pages: 306

ISBN-13: 0199749051

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No developed nation relies exclusively on the private sector to finance health care for citizens. This book begins by exploring the deficiencies in private health insurance that account for this. It then recounts the history and examines the legal character of America's public health care entitlements - Medicare, Medicaid, and tax subsidies for employment-related health benefits. These programs are increasingly embattled, attacked by those advocating privatization (replacing public with private insurance); individualization (replacing group and community-based insurance with approaches based on individual choice within markets); and devolution (devolving authority over entitlements to state governments and to private entities). Jost critically analyzes this movement toward disentitlement. He also examines the primary models for structuring health care entitlements in other countries - general taxation-funded national health insurance and social insurance - and considers what we can learn from these models. The book concludes by describing what an American entitlement-based health care system could look like, and in particular how the legal characteristics of our entitlement programs could be structured to support the long-term sustainability of these vital programs.

Unequal Treatment
Unequal Treatment

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2009-02-06

Total Pages: 781

ISBN-13: 030908265X

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Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Health Care Law and Ethics
Health Care Law and Ethics

Author: Mark A. Hall

Publisher: Aspen Publishing

Published: 2018-02-26

Total Pages: 2168

ISBN-13: 1454897651

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Health Care Law and Ethics, Ninth Edition offers a relationship-oriented approach to health law—covering the essentials, as well as topical and controversial subjects. The book provides thoughtful and teachable coverage of every aspect of health care law. Current and classic cases build logically from the fundamentals of the patient/provider relationship to the role of government and institutions in health care. The book is adaptable to both survey courses and courses covering portions of the field. Key Features: New authors Nick Bagley and Glenn Cohen Incorporated anticipated changes to the Affordable Care Act More current cases and more streamlined notes, including ones on medical malpractice, bioethics, and on finance and regulation More coverage of “conscientious objection” and “big data” - Discussion of new “value based” methods of physician payment - Expanded coverage of “fraud and abuse” Current issues in public health (e.g., Ebola, Zika) and controversies in reproductive choice (e.g., Hobby Lobby) Coverage of cutting-edge genetic technologies (e.g., gene editing and mitochondrial replacement)

Model Rules of Professional Conduct
Model Rules of Professional Conduct

Author: American Bar Association. House of Delegates

Publisher: American Bar Association

Published: 2007

Total Pages: 216

ISBN-13: 9781590318737

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The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.