Regulating Managed Care

In today's market-driven health care system, issues such as consumer choice, access to specialists, denials of coverage, and "drive-through" methods of care delivery have been thrust to the forefront of the managed care debate. Wanting nothing more than to create a managed care system that is accessible and affordable--to all Americans-- policy makers, clinicians, and consumers are working to find the right balance between competition and regulation that will insure a high quality and compassionate health care system. But regulating markets is no easy task, and individuals-even those with similar objectives-differ on the major questions to be resolved. Can managed care be effectively regulated?
Led by Stuart Altman, Uwe Reinhardt, and David Shactman, Regulating Managed Care brings together twenty-six of the foremost health policy experts, offering the rare opportunity to listen in while they debate this critical social issue. These influential contributors-including managed competition's architect, Alain Enthoven-provide leaders essential background on the critical issues, summarize key survey findings on how Americans feel about managed care, assess what areas are thought to need regulation, and examine the effect of proposed regulation on health care access, cost, and quality.
From policy to practicality, Regulating Managed Care gives health care executives, board members, and policy makers insight into the tough choices facing policy makers and the critical issues involved in ultimately improving the quality of medical services for the communities they serve.

Managing Managed Care

What should be government's role in a market-orientedhealth care system?
What's the appropriate amount of regulation?
Who should regulate-states, federal government, or market forces?
What role do the courts play in this regulation?
Are there existing models that might guide leaders in designing an effective regulatory structure?

Welcome to the great managed care debate. In Regulating Managed Care, twenty-six of the nation's leading health policy experts give health care administrators, clinicians, and policy makers insight into the issues behind this critical exchange and provide leaders with a road map to assess the policy options available to protect the quality of our health care delivery system.

"This collection of papers, from an extraordinary group of authors, makes a valuable contribution to the ongoing policy debate and will be of interest to anyone concerned with the future of our health care system."
--Charles A. Sanders, retired chairman and CEO, Glaxo Inc., and former general director, Massachusetts General Hospital

"This balanced collection of cutting-edge papers reviewing the theory and practice of health regulation is a must read for those who regulate and for those regulated by this market-moving the debate from whether to regulate to how to do this most difficult task more effectively."
--W. David Helms, CEO, Association for Health Services Research and president, Alpha Center

In recent years, there has been steady increase in the interest shown in both big data analytics and the use of information technology (IT) solutions to improve healthcare services. Despite the growing interest, there are limited materials, to addressing the needs and challenges posed by the activities and processes including the use of big data. From IT solutions' perspectives, this book aims to advance the deployment and use of big data analytics to increase patients' big data usefulness and improve healthcare service delivery. The book provides significant insights and useful guide on how to access and manage big data, in improving healthcare service delivery. The book contributes a fresh perspective, which primarily comes from the complementary use of analytics approach with actor-network theory (ANT), and other techniques, in advancing healthcare service delivery. Accessing and managing healthcare big data have always been a challenging exercise. Due to the sensitivity of the health sector, the focus on patients' big data is from either technical or social perspective. Thus, the book employs sociotechnical theories, ANT and structuration theory (ST) as lenses to examine and explain the factors that enable and constrain the use of patients' big data for health services. By doing so, the book brings a different dimension and advance health service delivery. Providing a timely and important contribution to this critical area, this book is a valuable, international resource for academics, postgraduate students and researchers in the areas of IT, big data analytics, data management and health informatics.

Unique selling point: Combines theory with practice and applications for advanced intelligent healthcare informatics Core audience: Researchers and academics in healthcare informatics and machine learning Place in the market: Reference work

This volume presents state-of-the-art reporting on how to measure many of the key variables in health communication. While the focus is on quantitative measures, the editors argue that these measures are centrally important to the study of health communication. The chapters emphasize constructs, scales, and up-to-date reports and evidence about key social science constructs and ways of measuring them, whether your interest is in patient-provider dyadic communication, uncertainty management, self-efficacy, disclosure, social norms, social support, risk perception, health care team performance, message design and effects, health and numerical literacy, communication satisfaction, social influence and persuasion, stigma, health campaigns, reactance, or other topics. Students, researchers, and policymakers will find this book an accessible resource for planning and reviewing research studies and proposals.

Over the past decade or so, we have seen a multitude of improvement programmes and projects to improve the safety of patient care in healthcare. However, the full potential of these efforts and especially those that seek to address an entire system has not yet been reached. The current pandemic has made this more evident than ever. We have tended to focus on problems in isolation, one harm at a time, and our efforts have been simplistic and myopic. If we are to save more lives and significantly reduce patient harm, we need to adopt a holistic, systematic approach that extends across cultural, technological, and procedural boundaries. Patient Safety Now is about the fact that it is time to care for everyone impacted by patient safety, how we need to take the time to care for everyone in a meaningful way and how hospitals need to enable staff time to care safely. This book builds on the author's two previous books on patient safety. Rethinking Patient Safety talked about ways in which we need to rethink patient safety in healthcare and describes what we've learned over the last two decades. Implementing Patient Safety talked about what we can do differently and how we can use those lessons learned to improve the way we implement patient safety initiatives and encourage a culture of safety across a healthcare system. Patient Safety Now unites the concepts, theories and ideas of the previous two books with updated material and examples, including what has been learned by patient safety specialists during a pandemic. Patient Safety Now provides the reader with a unique view of patient safety that looks beyond the traditional negative and retrospective approach to one that is proactive and recognizes the impact of conditions, behaviours and cultures that exist in healthcare on everyone. It is written not only for healthcare professionals and patient safety personnel, but for patients and their families who all want the same thing. Too often when things go wrong, relationships quickly become adversarial when in fact this can be avoided by recognizing that, rather than being in separate camps, there are shared needs and goals in relations to patient safety.

In nowadays aging society, many people require mobility assistance. Sometimes, assistive devices need a certain degree of autonomy when users' disabilities difficult manual control. However, clinicians report that excessive assistance may lead to loss of residual skills and frustration. Shared control focuses on deciding when users need help and providing it. Collaborative control aims at giving just the right amount of help in a transparent, seamless way. This book presents the collaborative control paradigm. User performance may be indicative of physical/cognitive condition, so it is used to decide how much help is needed. Besides, collaborative control integrates machine and user commands so that people contribute to self-motion at all times. Collaborative control was extensively tested for 3 years using a robotized wheelchair at a rehabilitation hospital in Rome with volunteer inpatients presenting different disabilities, ranging from mild to severe. We also present a taxonomy of common metrics for wheelchair navigation and tests are evaluated accordingly. Obtained results are coherent both from a quantitative and qualitative point of view.

By analysing the roles and problems faced by international regimes as major players in global health governance, this book looks into the root causes of the often insufficient supply of global public goods for health and of the deficiencies in current global health governance. Combining several different methods of analysis and methodologies, this book sketches out the landscape of international public health governance involving a range of international actors. These include the World Health Organization, the World Trade Organization, the Biological Weapons Convention and international human rights regimes. Through a novel theoretical framework that synthesises the theory of securitisation, public goods and international regimes, the author then focuses on factors that have resulted in observed deficiencies in global health governance. Based on these examinations, the book also tries to explore feasible approaches for institutional refinement and innovations for greater effectiveness in global health governance. The book will appeal to academics and policy makers interested in global health, international relations and international law.

This book explores the emerging economic reality of health data pools from the perspective of European Union policy and law. The contractual sharing of health data for research purposes is giving rise to a free movement of research data, which is strongly encouraged at European policy level within the Digital Single Market Strategy. However, it has also a strong impact on data subjects' fundamental right to data protection and smaller businesses and research entities ability to carry out research and compete in innovation markets. Accordingly the work questions under which conditions health data sharing is lawful under European data protection and competition law. For these purposes, the work addresses the following sub-questions: i) which is the emerging innovation paradigm in digital health research?; ii) how are health data pools addressed at European policy level?; iii) do European data protection and competition law promote health data-driven innovation objectives, and how?; iv) which are the limits posed by the two frameworks to the free pooling of health data? The underlying assumption of the work is that both branches of European Union law are key regulatory tools for the creation of a common European health data space as envisaged in the Commissions 2020 European strategy for data. It thus demonstrates that both European data protection law, as defined under the General Data Protection Regulation, and European competition law and policy set research enabling regimes regarding health data, provided specific normative conditions are met. From a further perspective, both regulatory frameworks place external limits to the freedom to share (or not share) research valuable data.

Patient mobility across Europe is markedly increasing and new generations will actively ask to be treated by the health-care system that best meets their needs. At a political level, the EU issued the EU Directive no. 24/2011/CE of 9th March 2011 concerning the application of patients' rights in cross-border health care andhas contributed to improving the level of freedom of choice for the European citizen, but it does not seem to have increased actual patient mobility across Europe. Freedom to choose is necessary to grant the people of Europe the same access to public-sector health-care services. The latter is a key instrument for an efficiently functioning "single market" ensuring real mobility within the EU.

The aim of this book is to study the current European health care market and discuss the hypothesis of a European right of citizenship with reference to health-care services. It examines patients' mobility from several perspectives: determinants of patient mobility, governance of cross-border mobility at EU level as concerns patients and health-care professionals, policy implications, and case studies. It is intended for health researchers, decision-makers and professionals concerned with health-care provision and patient mobility. The goal is to provide, through scientific and methodological rigor, new informative tools useful for the implementation of new policies in the health-care sector in order to implement effective health-care integration in the European Union."

System wide health reform has become the norm across the globe, forcing health care delivery organizations to critically examine the ways in which they are structured and operate on a day to day basis. Resource scarcity has become common while at the same time, quality and clinical outcomes become the basis upon which these organizations are measured and compared with one another. This volume of "Advances in Health Care Management" includes contributions from key academic thought leaders from around the world who critically examine how health reform impacts the macro, meso and micro level strategy and policy decisions of healthcare organizations.

The rise and spread of Covid-19 in the beginning of 2020 presents a once-in-a-century challenge and opportunity for decision makers, managers, scholars, and citizens to understand the risks, mitigate its impact and prepare for future crises. Drawing on a global network of scholars, this book presents a comparative analysis of ten nations' response to a global pandemic, while operating nominally under the framework of the World Health Organization. The book introduces the concept of 'collective cognition' as an analytic lens for examining the nations' response to Covid-19 during the first six months of the emerging pandemic (January - June 2020) and draws out insights for improving systems of global risk management. This book addresses four primary audiences: policy-makers and leaders in nations struggling to contain viruses while guiding their societies under threat; academic researchers, students, and educators engaged in preparing the next generation of professionals committed to investigating emerging risk: managers of non-profit and private organizations that operate and maintain the networks of social, technical, and economic services that are essential to functioning communities; and the informed general public interested in understanding this extraordinary sequence of events and in managing the novel risk of COVID-19 in a more informed, responsible way.

This contributed volume draws a vital picture of the health care sector, which, like no other is affected by technology push and stakeholder pull. Innovative product and service solutions emerge, which have to integrate different stakeholders' interests. This book studies current challenges in health care management from different perspectives. Research articles analyze the situation in the health care sector and present solutions in the following areas: the health care system; hospitals; teams in health care; patients' perspectives; assessment of technologies and innovations; and toolkits for organizing health care. All these contributions summarize pressing hot topics in the health care sector, analyze their future potential, and derive managerial implications. Outstanding best practices throughout Europe are presented in the case study section of the book. Consequently, the book closes the gap between science and practical application by addressing not only readers from academia but also practitioners working in the health care industry.

The desperate need for a vast part of the global population to access better medicines in more certain ways is one of the biggest concerns of the modern era.
"Pills for the Poorest" offers a new perspective on the much-debated issue of the links between intellectual property and access to medication. Using ethnographic case studies in Djibouti and Ghana, and insights from actor-network theory, it explores the ways in which TRIPs and pharmaceutical patents are translated in the daily practices of those who purchase, distribute, and use (or fail to use) medicines in sub-Saharan Africa. It suggests that focusing on routine practices and the material deployment of intellectual property significantly enriches our understanding of the complex dynamics that animate the field of access to medicines and helps relocate the role of law within those processes. It demonstrates how intellectual property affects access to medicines in ways that are often discreet, indirect and forgotten. By exploring these complex mechanisms, it seeks to ask questions about the modes of actions of pharmaceutical patents, but also, more generally, about the complexity of legal objects.

This book focusses on the Internet of Things (IoT) and Data Mining for Modern Engineering and Healthcare Applications and the recent technological advancements in Microwave Engineering, Communication and applicability of newly developed Solid State Technologies in Bio-medical Engineering and Health-Care. The Reader will be able to know the recent advancements in Microwave Engineering including novel techniques in Microwave Antenna Design and various aspects of Microwave Propagation. This book aims to showcase, the various aspects of Communication, Networking, Data Mining, Computational Biology, Bioinformatics, Bio-Statistics and Machine Learning. In this book, recent trends in Solid State Technologies, VLSI and applicability of modern Electronic Devices in Bio-informatics and Health-Care is focused. Furthermore, this book showcases the modern optimization techniques in Power System Engineering, Machine Design and Power Systems. This Book highlights the Internet of Things (IoT) and Data Mining for Modern Engineering and Healthcare Applications and the recent technological advancements in Microwave Engineering, Communication and applicability of newly developed Solid State Technologies in Bio-medical Engineering and Health-Care for day-to-day applications. Societal benefits of Microwave Technologies for smooth and hustle-free life are also areas of major focus. Microwave Engineering includes recent advancements and novel techniques in Microwave Antenna Design and various aspects of Microwave Propagation. Day-to-Day applicability of modern communication and networking technologies are a matter of prime concern. This book aims to showcase, the various aspects of Communication, Networking, Data Mining, Computational Biology, Bioinformatics, Bio-Statistics and Machine Learning. Role of Solid Sate Engineering in development of modern electronic gadgets are discussed. In this book, recent trends in Solid State Technologies, VLSI and applicability of modern Electronic Devices in Bio-informatics and Biosensing Devices for Smart Health care are also discussed. Features: This book features Internet of Things (IoT) and Data Mining for Modern Engineering and Healthcare Applications and the recent technological advancements in Microwave Engineering, Communication and applicability of newly developed Solid State Technologies in Bio-medical Engineering and Smart Health-Care Technologies Showcases the novel techniques in Internet of Things (IoT) integrated Microwave Antenna Design and various aspects of Microwave Communication Highlights the role of Internet of Things (IoT) various aspects of Communication, Networking, Data Mining, Computational Biology, Bioinformatics, Bio-Statistics and Machine Learning Reviews the role of Internet of Things (IoT) in Solid State Technologies, VLSI and applicability of modern Electronic Devices in Bio-informatics and Health-Care In this book, role of Internet of Things (IoT) in Power System Engineering, Optics, RF and Microwave Energy Harvesting and Smart Biosensing Technologies are also highlighted

Nowadays, raw biological data can be easily stored as databases in computers but extracting the required information is the real challenge for researchers. For this reason, bioinformatics tools perform a vital role in extracting and analyzing information from databases. Bioinformatics Tools and Big Data Analytics for Patient describes the applications of bioinformatics, data management, and computational techniques in clinical studies and drug discovery for patient care. The book gives details about the recent developments in the fields of artificial intelligence, cloud computing, and data analytics. It highlights the advances in computational techniques used to perform intelligent medical tasks. Features: Presents recent developments in the fields of artificial intelligence, cloud computing, and data analytics for improved patient care. Describes the applications of bioinformatics, data management, and computational techniques in clinical studies and drug discovery. Summarizes several strategies, analyses, and optimization methods for patient healthcare. Focuses on drug discovery and development by cloud computing and data-driven research The targeted audience comprises academics, research scholars, healthcare professionals, hospital managers, pharmaceutical chemists, the biomedical industry, software engineers, and IT professionals.

This book focuses on Africa's challenges, achievements, and failures over the past several centuries using an interdisciplinary approach that combines theory and fact and evidence-based practices and interventions in public health, and argues that most of the health problems in Africa are not a result of scarce or lack of resources, but of the misconceived and misplaced priorities that have left the continent behind every other on the globe in terms of health, education, and equitable distribution of opportunities and access to (quality) health as agreed by the United Nations member states at Alma-Ata in 1978.

Written in the middle of a pandemic, this book examines the effect of COVID-19 on regional and global security threats in the first 18 months of the crisis. Throughout history, epidemics have disrupted human civilisations, changed the structure of societies, decided the outcome of wars and prompted incredible technological innovation. Despite massive progress in science, institution-building and cooperation over the past 100 years, COVID-19 has revealed the weaknesses of a world under-prepared for a new disease - that had been widely expected and long overdue! This edited volume brings together leading security experts from Africa, Asia, Europe, the Americas and the Middle East to share their analysis of the COVID-19 outbreak and its impact on major security threats, including the rise of terrorists and criminal networks and global power politics. The book highlights important lessons learnt from all corners of the planet, in particular the need for cross-sectional, regional and international cooperation and solidarity when it comes to facing any transnational security threat that does not respect political boundaries.

The Tidal Model represents a significant alternative to mainstream mental health theories, emphasising how those suffering from mental health problems can benefit from taking a more active role in their own treatment. Based on extensive research, The Tidal Model charts the development of this approach, outlining the theoretical basis of the model to illustrate the benefits of a holistic model of care which promotes self-management and recovery. Clinical examples are also employed to show how, by exploring rather than ignoring a client's narrative, practitioners can encourage the individual's greater involvement in the decisions affecting their assessment and treatment. The appendices guide the reader in developing their own assessment and care plans. The Tidal Model's comprehensive coverage of the theory and practice of this model will be of great use to a range of mental health professionals and those in training in the fields of mental health nursing, social work, psychotherapy, clinical psychology and occupational therapy.

Spanish in Health Care fills an important gap by offering a panoramic overview of the research on Spanish in health settings that is emerging from a variety of disciplines. Synthesizing research from diverse disciplines such as sociolinguistics, discourse analysis, health services research, behavioral health research, health policy and administration, and social epidemiology, the volume offers a uniquely unified approach to the subject of Spanish in healthcare. This volume will be of interest to researchers in Spanish linguistics, sociolinguistics, health communication, and languages for specific purposes.

The allied health professions have gained legitimacy through the pursuit of research evidence and the standardisation of practice. Yet there remains very little analysis or understanding of these professions. Adopting theory from the sociology of health professions, this unique text explores the sociological, economic, political and philosophical pressures that have shaped the professions. Drawing on case studies and examples from occupations including optometrists, occupational therapists and physiotherapists to emerging vocations, including pedorthists and allied health assistants, this book offers an innovative comparison of allied health professions in Australia and Britain. By telling the story of their past, this original book prepares the allied health professions for a new and different future.

Diseases are everyday, ordinary occurrences intimately related to people's daily lives. However, as the metaphor of the "Sick Man of East Asia" emerged against the backdrop of a weak modern China, health care and the curing of diseases were turned into grand state politics with far-reaching implications. This book, starting with the argument for diseases being metaphors, describes and interprets such incidents in China's history as the Abolishment of Traditional Chinese Medicine, the Patriotic Hygiene Campaign and the Cooperative Medical Services. In an effort to reveal the internal logic of disease politics in the transformation of the state-people relationship, the book analyzes key aspects including the politicization and inclusion of diseases in state governance, the double disciplining of hygiene, legitimacy construction of the state, the remaking of the nationals, and the expansion of the "publicness" of the state. The book argues that disease politics in modern China has developed following the path from nationals to the people, and then to citizens, or from crisis politics and mobilization politics to life politics. In addition, a marked change has occurred in China's state building: increasingly standard, rationalized and institutionalized means have been employed while the non-standard means, such as large-scale mobilization and ideological coercion, had been historically used in China.

This comprehensive book brings together research published during 2021 analysing the impact of the Covid-19 pandemic on the economy - on output and employment, on inequality, and on public policy responses. The Covid-19 pandemic has been the greatest public health crisis for a century - since the 'Spanish Flu' pandemic of 1919. The economic impact has been equally seismic. While it is too early to measure the full economic cost - since much of this will continue to accumulate for some time to come - it will certainly be one of the greatest global economic shocks of the past century. Some chapters in this edited volume report on specific countries, while some take a comparative look between countries, and others analyse the impact upon the global economy. Even before the Covid-19 pandemic, there had been calls for a 'great reset' in face of the climate crisis, the increased income and wealth inequality, and the need to avoid further global financial crisis. With the devastating Covid-19 pandemic - a harbinger for further such pandemics - there is an even greater need for a reset, and for the reset to be that much greater. The chapters in this book were originally published as special issues in the journal International Review of Applied Economics.

Monitoring real-time human health through nanosensors Sensing human health through nanobiosensors Diagnosis of medical disease through nanobiosensors Using wearable sensors for remote healthcare monitoring system Monitoring patients in real-time with point-of-care technology Detecting biomarkers of cancer and other diseases

Poor Families in America's Health Care Crisis examines the implications of the fragmented and two-tiered health insurance system in the United States for the health care access of low-income families. For a large fraction of Americans their jobs do not provide health insurance or other benefits and although government programs are available for children, adults without private health care coverage have few options. Detailed ethnographic and survey data from selected low-income neighborhoods in Boston, Chicago, and San Antonio document the lapses in medical coverage that poor families experience and reveal the extent of untreated medical conditions, delayed treatment, medical indebtedness, and irregular health care that women and children suffer as a result. Extensive poverty, the increasing proportion of minority households, and the growing dependence on insecure service sector work all influence access to health care for families at the economic margin.

Patients with unmet needs will continue to increase as no viable nor adequate treatment exists. Meanwhile, healthcare systems are struggling to cope with the rise of patients with chronic diseases, the ageing population and the increasing cost of drugs. What if there is a faster and less expensive way to provide better care for patients using the right digital solutions and transforming the growing volumes of health data into insights? The increase of digital health has grown exponentially in the last few years. Why is there a slow uptake of these new digital solutions in the healthcare and pharmaceutical industries? One of the key reasons is that patients are often left out of the innovation process. Their data are used without their knowledge, solutions designed for them are developed without their input and healthcare professionals refuse their expertise. This book explores what it means to empower patients in a digital world and how this empowerment will bridge the gap between science, technology and patients. All these components need to co-exist to bring value not only to the patients themselves but to improve the healthcare ecosystem. Patients have taken matters into their own hands. Some are equipped with the latest wearables and applications, engaged in improving their health using data, empowered to make informed decisions and ultimately are experts in their disease(s). They are the e-patients. The other side of the spectrum are patients with minimal digital literacy but equally willing to donate their data for the purpose of research. Finding the right balance when using digital health solutions becomes as critical as the need to develop a disease-specific solution. For the first time, the authors look at healthcare and technologies through the lens of patients and physicians via surveys and interviews in order to understand their perspective on digital health, analyse the benefits for them, explore how they can actively engage in the innovation process, and identify the threats and opportunities the large volumes of data create by digitizing healthcare. Are patients truly ready to know everything about their health? What is the value of their data? How can other stakeholders join the patient empowerment movement? This unique perspective will help us re-design the future of healthcare - an industry in desperate need for a change.