Effects of Managed Care on Surgical Care

Managed care programs are increasing in number with the goals of controlling health care costs and continuing to provide quality care. Questions exist, however, regarding the maintenance of the quality of care provided to patients under a managed care regime. This study examines the effects of managed care on surgical care.

Assessing the quality of care provided to patients is the essential foundation for improving care (Gagel, 1995). With respect to managed care regimes, assessments of the quality of care delivered to patients under such regimes are mixed. Measures include process and outcomes criteria. At a general level, the quality of care is generally found to be comparable in managed care and fee-for-service settings. Evidence shows that managed care patients tend to receive more preventive tests, procedures, and examinations than those in fee-for-service settings. Outpatient care satisfaction, however, tends to be rated lower in managed care settings. Care provided in inpatient settings is an area of increasingly frequent and harsh criticisms of managed care. Under a managed care regime, capitation, copayments, and deductibles limit the use of services, particularly in relation to inpatient hospital care (Quickel, 1996).

Surgical care occurs in both outpatient settings (where patient satisfaction is lower under managed care than under fee-for-service reg

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ical practice parameter, clinic practice guideline, and clinical protocols. To clarify guideline development, one differentiation that is made between the different names for standards is that practice guidelines are intended to be more flexible than protocols or standardsùdocuments that recommend practice patterns that are based on observed outcomes and that result in uniformly accepted health and economic consequences. Generally, an accepted premise is that practice guidelines should be followed in most cases, but that unique situations cause justifiable deviations from guidelines to be common (Johnson & Feldman, 1995). As supplements to clinical practice guidelines and protocols, many local practices and managed care organizations create documents called critical pathways. These documents, as is true of clinical practice guidelines, outline the key events associated with managing a specific disease. Unlike many practice guidelines, however, critical pathways are developed by caregivers from all disciplines who are involved with patients and their families. Critical pathways, thus, may include locally accepted practice in areas where a practice guideline might list only a series of "unproved options" (Johnson & Feldman,
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Some common words found in the essay are:
O'Connor Lanning, Austin Korff, Tischler Unutzer, Sunshine Evens, Pollard Gross, Johnson Feldman, Implications Study, Clinton Administration, Bergman Shiono, Beaudin Chambre, managed care, health care, care organizations, managed care organizations, quality care, surgical care, health care services, care services, practice guidelines, primary care, care delivered, care patients, health care system, o'connor lanning 1992, health care delivery,
Approximate Word count = 9600
Approximate Pages = 38 (250 words per page)

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