Managed care woes: industry trends and conflicts.

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Abstract

Although managed care plans have had success in controlling costs, they now face challenges on many fronts, including tighter profit margins, pressure for broader provider networks, increasing clout of hospitals and physicians and more demand for consumer protection regulation. Underlying these trends is a fundamental conflict between health plans and consumers, who are demanding--and, in many cases, getting--greater control over their health care delivery and services. This Issue Brief reports on a roundtable convened by the Center for Studying Health System Change to discuss these trends and conflicts and how they may play out over the next number of years. (1) Managed care challenges, (2) Redefining care delivery, (3) Investing in information systems, (4) Center survey findings about managed care, (5) Who's in control, (6) HCFA as a value purchaser, (7) Backlash fueled by many groups, (8) What about the future.

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管理式医疗困境:行业趋势和冲突。
尽管管理式医疗计划在控制成本方面取得了成功,但它们现在面临着许多方面的挑战,包括利润率更低,对更广泛的供应商网络的压力,医院和医生的影响力不断增强,以及对消费者保护法规的更多要求。这些趋势的背后是健康计划和消费者之间的根本冲突,消费者要求——在许多情况下,也得到了——对医疗保健提供和服务的更大控制权。本期《问题简报》报道了卫生系统变革研究中心召集的圆桌会议,讨论这些趋势和冲突,以及它们在今后几年可能如何发挥作用。(1)管理式医疗面临的挑战,(2)重新定义医疗服务,(3)投资信息系统,(4)关于管理式医疗的中心调查结果,(5)谁在控制,(6)HCFA作为价值购买者,(7)许多群体引发的反弹,(8)未来会怎样。
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Small employers and self-insured health benefits: too small to succeed? Employer-sponsored health insurance: down but not out. Rising hospital employment of physicians: better quality, higher costs? Key findings from HSC's 2010 site visits: health care markets weather economic downturn, brace for health reform. Physicians slow to e-mail routinely with patients.
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