Literature Review: In-Hospital Patient Care
The term, managed care, refers to physician management. Managed care plans are based on entire networks of health care providers. For the most part, recent changes within the health care industry have favored managed care facilities. These organizations are able to dispense high-quality, cost-effective services. Hospital expenses are typically increased by such factors as unnecessary hospital days, adverse events, and hospital readmissions. However, prospective payment systems, capitated agreements, retrospective denial of payment, and other reforms may increase hospitals' fiscal responsibilities. Managed care facilities must therefore find ways to improve operations and minimize health care costs. One possible means by which expenditures might be reduced involves primary care. In many managed care hospitals, in-hospital physicians attend to patients' medical needs. Furthermore, these providers are able make sure that health care resources are utilized efficiently.
Miller and Luft (1994) compares managed care plans and indemnity plans. The term "managed care plan" may describe any plan employing an organized group of providers. Typically, a health benefit intermediary contracts with an employer or the government to provide health care to its employees (Miller & Luft, 1994, pp. 1512-1518). According to the Health Maintenance Organization Act of 1973, many employers are required to provide such benefits. This intermediary can be either a health maintenance organization (HMO), an insurance carrier, or an independent provider organization. HMO'S, which arose during the 1970s, compete with indemnity insurance carriers; independent provider organizations contract directly with employers.
Among managed care plans, the interrelationship between the health benefit intermediary and the health care provider networks may vary considerably. For example, there are five different...