Does managed care reduce the costs of medical care while leaving
the quality of treatment at least unchanged? What instruments
should be employed to prevent risk selection? How can medical
decision making be based on more rational criteria? This book
consists of three major studies, each addressing a specific
question related to the current debate on reforms in the health
care sector. Insurers offering managed care contracts have the
right to deny coverage for treatment prescribed by an insured's
physician. In the US, such practices have provoked a wave of
criticism against managed care. The first study shows that
monitoring physicians' decisions can generally raise the efficiency
of health care provision. However, insurers tend to intervene too
much in medical decision making, such that consumer welfare may
also decline. If premium payments do not reflect individual risk
types, insurers have an incentive to practice risk selection (cream
skimming). To prevent this, risk adjustment schemes have been
introduced in several countries. The second study takes up the
critique against conventional risk adjustment and shows that an
inaccurate adjustment scheme may even have detrimental effects on
social welfare. The optimal payment scheme in the model framework
involves partial cost reimbursement based on the insurer's
information. Watchfully waiting involves monitoring a patient's
health state over time and deciding whether to undertake a medical
intervention, or to continue waiting. The third study contains a
formal model of the watchfully waiting process. Optimal decision
rules for switching to direct medical intervention are derived. The
approach could be applied to a wide range of decision problems in
health economics and medicine.
General
Imprint: |
Josef Eul Verlag Gmbh
|
Country of origin: |
United States |
Release date: |
November 2009 |
First published: |
November 2009 |
Authors: |
Elisabeth Meyer
|
Dimensions: |
210 x 148 x 9mm (L x W x T) |
Format: |
Paperback - Trade
|
Pages: |
160 |
ISBN-13: |
978-3-89936-864-2 |
Categories: |
Books >
Business & Economics >
Economics >
General
Promotions
|
LSN: |
3-89936-864-9 |
Barcode: |
9783899368642 |
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