Managed care organization

C. N. Swenson and G. Fundale, Observational cohort study of switching warfarin sodium products in a managed care organization, Am J. Health Syst. Pharm, 57, 452 (2000). 

Both primary care physicians and specialists may be paid via capitation arrangements, but the arrangement is more common for primary care physicians. In one survey of managed care organizations, 37% used capitation as the main method of... 

Health maintenance organizations are the most restrictive type of managed care organization, and consumer dissatisfaction with restricted choice in HMOs likely was a significant factor in the growth of point of service (POS) plans. POS plans sometimes are referred to as open-ended HMOs. Like HMOs, enrollees typically select a primary care provider and pay no fee or a small copayment to see participating providers. POS plans differ from HMOs in that patients can receive coverage from physicians outside the network. However, patients pay more for care received from physicians outside the network and often must pay the full... 

Today s healthcare policy-makers, including government officials, health insurance companies and managed-care organizations, are faced with the reality of limited resources for healthcare and the knowledge that much medical care is of uncertain value. The value of vitamin E therapy in Alzheimer s disease, for example, is still unclear, but some physicians have recommended it for years without any real measures of its effect on the disease. 

Mandatory drug product selection on the basis of price is common practice in the USA because third-party payers (insurance companies, health maintenance organizations, etc) enforce money-saving regulations. If outside a managed care organization, the prescriber can sometimes override these controls by writing "dispense as written" on a prescription... 

Hatoum HT, Kania CM, Kong SX, Wong JM, Mendelson WB (1998) Prevalence of insomnia a survey of the enrollees at five managed care organizations. Am JManag Care 4 79-86... 

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