The accepted insurance model is to provide care intended to make sick people well. This might include screening, and some preventive actions such as immunizations. But there are new arguments that small investments in persuading people to live healthier lifestyles will result in large reductions in cost in later years.
Now that tiered formularies rule the land, what many suspected is being demonstrated: Compliance is suffering and so, too, are patients.
Deciding to seek NCQA accreditation sets an HMO up for lots of preparatory work. Make sure the effort is well spent.
Physicians who make the move to the administrative side find a lot of tough decisions waiting for them.
Yes, health care is a business, but altruistic plans would like to cooperate with others. The Leapfrog Group has set up a simple mechanism to do this.
John A. Marcille
Only a small percent of a typical health plan's population takes medicine for conditions outside the generalist's scope. But it's a big portion of the drug bill.
When physicians think it is acceptable to withhold care from lawyers involved in malpractice suits, does it signal a breakdown of the social order?
Michael S. Victoroff, MD
Legislation & Regulation
The senate majority leader, a surgeon who owns a large stake in a chain of hospitals, puts forth far-reaching proposals for reforming the health care system.
The Formulary Files
Companies test new approaches to funding the pharmacy benefit with the goal of saving money overall.
Diseases will soon be defined by biochemical pathways and genetic interactions. Biochips may identify patients likely to respond to therapeutic agents.
Thomas Morrow, MD
Managed Care Outlook