Managed Care: Made in America / Edition 1

by Arnold Birenbaum

Overview

This book focuses on how a distinctly American product—managed care—got its start, how it works, and what needs to be adjusted in the future. As Birenbaum makes clear, this book is about social change. It is about doctors contracting with health maintenance organizations (HMOs) and being subject to their rules; about the limited access to specialty care; and about the frugal use of hospital admissions and stays. Consumers and providers have had mixed experiences in these health-delivery systems. Birenbaum, a health-policy analyst, has created a synthesis of research studies and analyses of trends to chronicle these developments and to suggest remedies to correct the most unjust aspects of managed care.

This book is about social change. It is about doctors contracting with HMOs and being subject to their rules; about the limited access to specialty care; and about the frugal use of hospital admissions and stays. Consumers and providers have had mixed experiences with HMOs. Birenbaum, a health-policy analyst, has created a synthesis of research studies and analyses of trends to chronicle these developments and to suggest remedies to correct the most unjust aspects of managed care. This is important reading for anyone concerned with contemporary health care in America.

Product Details

ISBN-13:	9780275959166
Publisher:	Bloomsbury Academic
Publication date:	07/23/1997
Series:	Management; 34
Edition description:	New Edition
Pages:	208
Product dimensions:	6.14(w) x 9.21(h) x 0.50(d)
Lexile:	1440L (what's this?)

About the Author

ARNOLD BIRENBAUM, a health-care policy analyst, medical sociologist, and health services researcher, is Professor of Pediatrics at Albert Einstein College of Medicine and Associate Director of the University Affiliated Program for People with Developmental Disabilities, Rose F. Kennedy Center./e He has authored or edited 11 earlier books and monographs, including Putting Health Care on the National Agenda (Praeger, 1995), recipient of the American Medical Writers Association First Place Award-Allied Health Category.

Table of Contents

Preface
Introduction: Retrenchment and the Remaking of the Health-Care System
What Is Managed Care?
American Business Falls in Love with Managed Care
Medicaid Managed Care
Healthy and Unhealthy People at the HMO
How HMOs Assure Quality
Consumer Satisfaction
Professional Autonomy and Managed Care
Protecting Consumers and Providers through Legislation
The Growing Business of HMOs
Unresolved Issues Regarding Managed Care
Bibliographical Essay
Index

Editorial Reviews

Reviewer: William Gold, MD (Blue Cross Blue Shield of Minnesota)
Description: This is a referenced monograph on managed care.
Purpose: The book sets out lofty goals. It is intended to be a review of managed care with the promise of tracing its origins, describing how it works, and identifying areas where change is required. These are worthwhile goals and very timely in the overall life cycle of managed care. Unfortunately, the book fails to meet the reader's expectations. In fact, a reader who truly is interested in learning more about managed care may be left more confused than before.
Audience: Although the intended audience is health policy specialists and health professionals, the title would suggest a broader audience which might include consumers, providers, legislators, and others who have an interest in understanding managed care.
Features: The author has definitely identified many of the appropriate topics to be included in a book with this scope. The first chapter, "What is Managed Care?" should get the attention of anybody who is scanning the contents section. Topics covered in subsequent chapters lack organization and do not put the story of managed care together for the reader. For example, the chapter entitled "Physician Autonomy and Managed Care" is narrowly focused on one aspect of the providers' role in managed care. It omits more pertinent aspects of the role that providers have played in the origins of managed care. Topics like how providers are compensated, the scientific basis of medicine, and the changes within the profession of medicine over the past 40 years are not given adequate space.
Assessment: Unfortunately, this book suffers from basic problems that severely impact its overall value for a reader. The writing style, which at times is difficult to follow, makes it necessary to reread passages to obtain meaning and to reestablish the framework of the chapter or section. Some of the chapters are poorly organized and the subheadings do not help the reader. Anyone challenged to write a book on this topic must be careful not to let biases interfere with careful evaluation of the topic. The author states that this treatise is based on careful health services research. The author's background as a practicing physician is evident throughout the book. It was disappointing that more references were not included to support some of the statements and conclusions. Granted, managed care is a broad topic and the goals the author set out for himself may not be achievable in one book. Managed care is an experiment which is a reaction to scientific findings and social realities. It is part of the transition that societies go through as they struggle with issues of health, resources, and imbalance. The seeds of managed care began long before Clinton took office or the Kaiser health plan was established. Although the intent of this book is laudable, it does not deliver on its promise.

Doody's Review Service

2 Stars from Doody

This is a referenced monograph on managed care. The book sets out lofty goals. It is intended to be a review of managed care with the promise of tracing its origins, describing how it works, and identifying areas where change is required. These are worthwhile goals and very timely in the overall life cycle of managed care. Unfortunately, the book fails to meet the reader's expectations. In fact, a reader who truly is interested in learning more about managed care may be left more confused than before. Although the intended audience is health policy specialists and health professionals, the title would suggest a broader audience which might include consumers, providers, legislators, and others who have an interest in understanding managed care. The author has definitely identified many of the appropriate topics to be included in a book with this scope. The first chapter, ""What is Managed Care?"" should get the attention of anybody who is scanning the contents section. Topics covered in subsequent chapters lack organization and do not put the story of managed care together for the reader. For example, the chapter entitled ""Physician Autonomy and Managed Care"" is narrowly focused on one aspect of the providers' role in managed care. It omits more pertinent aspects of the role that providers have played in the origins of managed care. Topics like how providers are compensated, the scientific basis of medicine, and the changes within the profession of medicine over the past 40 years are not given adequate space. Unfortunately, this book suffers from basic problems that severely impact its overall value for a reader. The writing style, which at times is difficult to follow, makes itnecessary to reread passages to obtain meaning and to reestablish the framework of the chapter or section. Some of the chapters are poorly organized and the subheadings do not help the reader. Anyone challenged to write a book on this topic must be careful not to let biases interfere with careful evaluation of the topic. The author states that this treatise is based on careful health services research. The author's background as a practicing physician is evident throughout the book. It was disappointing that more references were not included to support some of the statements and conclusions. Granted, managed care is a broad topic and the goals the author set out for himself may not be achievable in one book. Managed care is an experiment which is a reaction to scientific findings and social realities. It is part of the transition that societies go through as they struggle with issues of health, resources, and imbalance. The seeds of managed care began long before Clinton took office or the Kaiser health plan was established. Although the intent of this book is laudable, it does not deliver on its promise.

William Gold

Focuses on how managed care got started, how it works, and what needs to be adjusted. Explains how service is improved by a third party stepping between the consumer and provider of health care for the sole purpose and function of skimming profit from the transaction. Birenbaum, a health-policy analyst, synthesizes research on such aspects as doctors being subject to HMO rules, limited access to specialty care, and the frugal use of hospital admissions and stays. Annotation c. by Book News, Inc., Portland, Or.

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