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Managed-care research, Part 1: Defining the domain.

Published on Nov 1, 1999in Journal of Nursing Administration1.206
· DOI :10.1097/00005110-199911000-00008
Jo-Ann Cook4
Estimated H-index: 4
,
Gail L. Ingersoll7
Estimated H-index: 7
,
Roxanne Spitzer2
Estimated H-index: 2
Abstract
: New research opportunities are arising in response to the changes associated with care delivery provided in managed-care environments. A review of the managed-care literature suggests five characteristics that are associated with the care delivery models currently in place. Each of these components needs investigation to determine which of them contribute to cost reductions and care delivery outcomes seen.
  • References (8)
  • Citations (11)
References8
Newest
#1James R. FriesH-Index: 91
#2C E KoopH-Index: 1
Last. Daniel G. WrightH-Index: 8
view all 5 authors...
PROLOGUE: Most of the recent reforms in health care delivery have been aimed at providing services more efficiently, and very few have considered the economic advantages of actually improving health. The authors of this paper argue that we have been too much consumed with the supply side of the health care equation and too little concerned with the demand side. The best way to reduce costs and improve health at the same time, they suggest, is not just to control the services provided but also to...
114 CitationsSource
8 Citations
#1William E. Welton (Allegheny College)H-Index: 3
#2Theodore A. Kantner (Allegheny College)H-Index: 1
Last. Sheila Moriber Katz (Allegheny College)H-Index: 1
view all 3 authors...
As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorr...
33 CitationsSource
#1Mark E. CowenH-Index: 17
#2Mary BannisterH-Index: 1
Last. Robert TildenH-Index: 1
view all 4 authors...
: The objective of this study was to demonstrate the value of a planning model for the design and evaluation of community health services. The health status of Washtenaw County, Michigan was modeled. Data were obtained from the Michigan Department of Public Health, Medstat Systems, and the medical literature for 32 diseases or conditions, representing approximately 85% of causes of death and 56% of medical payments (excluding medication costs). An expanded life-table approach was used for 16 age...
12 CitationsSource
: Changes occurring in the health care industry are substantive and constitute a paradigm shift. Nurse managers can participate in shaping the health care organization of the future by understanding six critical areas of transformation and their driving forces.
5 Citations
SUMMARY Enrollment in network-based managed care plans has grown rapidly, raising important questions about the actual impact of different types of managed care plans on health care use, expenditure, and quality of care. In this article, we analyze the literature on the performance of managed care plans relative to fee-for-service plans. We find strong evidence that staff-and group-model HMOs have lowered utilization and expenditure relative to fee-for-service while maintaining quality of care. ...
35 CitationsSource
#1Lanis L. HicksH-Index: 25
#2Stallmeyer JmH-Index: 1
Last. ColemanH-Index: 1
view all 3 authors...
: The emergence of managed care organizations offers many opportunities, challenges, and threats for nursing and nurses. The goal of these organizations (ensuring maximum value from resources used) is congruent with the basic philosophy of nursing, which focuses on the total needs of the patient, not just disease, and on maintaining the health of the individual to minimize the need for expensive health care services. Within the structure of managed care, however, there is also a need for strong ...
13 Citations
The current status of managed health care is described and its impact on hospital and pharmacy operations is summarized. In the 1980s, managed care evolved into a three-segment industry, comprising health maintenance organizations (HMOs), preferred-provider organizations, and fee-for-service plans. Five new trends are emerging as managed care, now an established part of the country's health-care delivery system, enters its second generation: dual- and triple-option plans with financial risk shar...
9 CitationsSource
Cited By11
Newest
#1Jennifer WenzelH-Index: 18
#2Richard H. Steeves (UVA: University of Virginia)H-Index: 22
The interest of managed care organizations (MCOs) in decreasing care and outcome variance and lowering costs has created many concerns including those pertaining to the complex and costly nature of cancer care. In this study, we used a hermeneutic phenomenological approach involving semistructured interviews of 14 women with breast cancer to examine MCO enrollees' experiences related to their cancer treatment. Results comprise two themes: managed care tasks and managing or mediating between the ...
12 CitationsSource
#1Jennifer Lynette Hardy (UOW: University of Wollongong)H-Index: 1
#1Mark A. Covaleski (UW: University of Wisconsin-Madison)H-Index: 24
This paper adapts the perspective of organizational contingency theory to consider the changing nature of how the economic impact of nursing care upon health care organizations is measured. It is argued that useful measures of the economic impact of nursing care are a function of environmental, organizational, and technological circumstances. The increasing and diverse demands of health care consumers (environmental), the dramatic restructuring and re-engineering of the health care delivery syst...
5 CitationsSource
#1Lynn UnruhH-Index: 19
#2Nancy Rudner LugoH-Index: 1
Last. Jacqueline Fowler ByersH-Index: 6
view all 4 authors...
Objective:Patient safety practices have primarily focused on providers, such as hospitals and ambulatory or long-term care. Based on the premise that most medical errors and patient safety problems arise from system issues, and that managed care constitutes the largest, most integrated system in hea
6 CitationsSource
Healthcare delivery systems in the United States are changing rapidly in response to socioeconomic forces. In the new competitive healthcare market, work has been redesigned, with hospitals changing their skill mix to include unlicensed assisitive personnel. Having previously described the more traditional models of care delivery, (JONA, June 2004), the authors will now discuss a variety of nontraditional practice models that have been developed to address the changing needs of healthcare. These...
14 CitationsSource
#1Angela Y. Lambing (HFHS: Henry Ford Health System)H-Index: 1
#2Denise L. C. AdamsH-Index: 1
Last. George Divine (HFHS: Henry Ford Health System)H-Index: 29
view all 4 authors...
Objective Less is known about nurse practitioners' (NPs') effectiveness in acute care than about their effectiveness in outpatient settings. This study investigated care activities and clinical outcomes for hospitalized geriatric patients treated by NPs compared with those treated by intern and resident physicians. Data Sources A descriptive comparative research design involved random selection of 100 inpatient geriatric patients and a convenience sample of 17 professional providers who staffed ...
17 CitationsSource
#1Katherine I. Miller (A&M: Texas A&M University)H-Index: 7
#2Julie Apker (A&M: Texas A&M University)H-Index: 1
Abstract This article explores how the role of the hospital nurse has been transformed by managed care, with a concentration on changes relevant to communicative relationships and processes. Two brief case analyses are considered to examine how hospital nurses have felt the impact of being on the "front lines" of managed care. Findings illustrate the utility of a communication perspective in understanding changes in nursing at individual, organizational, and system levels. Nurs Outlook 2002;50:1...
25 CitationsSource
Nurse administrators are searching for an expanded repertoire of strategies to attract and retain qualified nursing staff in today's managed care environment. This study examined hospital registered nurses' interpretations of managed care and the effects of those views on nurses' identification with their employing organization and the nursing profession. Findings show that nurses held greater identification with their occupation than their organization. Significant factors influencing nurses'at...
15 CitationsSource
2 CitationsSource
The study's purpose was to compare characteristics, service utilization, and outcomes of home health patients enrolled in fee-for-service (FFS) versus health maintenance organization (HMO) health plans. Results documented that HMO patients were healthier and used fewer resources than FFS patients. Outcomes for HMO patients were superior to those of FFS patients. Phi correlation coefficients showed that purchaser type was not a substantial predictor of patient outcomes. Home health staff need to ...
3 CitationsSource