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06:10 Oct 8, 2004
English to Chinese translations [Non-PRO] Medical - Medical (general)
Explanation: In the past decade managed care has become the predominant form of health care in many parts of the United States. More than 70 million Americans are enrolled in HMOs (health maintenance organizations) and almost 90 million are part of PPOs (preferred provider organizations). Overall enrollment numbers have peaked and are declining slightly in some areas, but managed care remains a dominant type of health care and coverage. State Legislatures have responded by passing numerous laws on the subject -- over 900 in the past eight years, in all 50 states. [See a definition of managed care].
Managed care is a term used to describe health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by: arrangements with selected providers to furnish a comprehensive set of health care services; explicit standards for selection of health care providers; formal programs for ongoing quality assurance and utilization review; and significant financial incentives for members to use providers and procedures associated with the plan. Managed care is a rapidly growing phenomenon in America. At the end of 1993, enrollment in the two most popular forms of managed care--health maintenance organizations and preferred provider organizations--was over 44 million and 55 million, respectively.
The goal of managed care is to control skyrocketing health care costs without sacrificing the quality of care. Managed care pursues those goals in a number of ways. Most managed care plans establish a limited network of providers. In some cases, instead of being reimbursed for the specific care they give patients, these providers agree to fixed payments based on the number of members enrolled in the plan. Thus, the network of providers shares risk: If the care provided is more expensive than the allotted payments, the providers absorb the loss. This arrangement (called capitation), in theory encourages providers to care for patients efficiently and to promote healthy behavior so expensive treatment is less often necessary. Other common tools of managed care include: