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Managed Care Blues and How to Cure Them / Edition 1

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Overview

Shattering the myths about what's wrong with managed health care, this penetrating introduction to managed care explains its origins and identifies its real achievements and shortcomings.

Walter A. Zelman and Robert A. Berenson argue that many criticisms of managed care tend to idealize the costly and fragmented insurance system it supplanted, without pinpointing the true inadequacies of today's managed care. In addition to providing reasoned answers to the most alarmist critiques of managed care, the authors maintain that it has not fulfilled its potential to improve the overall quality of care.

The authors propose thirteen concrete recommendations for raising quality in managed care programs, ranging from enacting additional legal protections and increased disclosure to putting the purchasing power in the hands of those who care most about quality -- individuals, rather than employers.

With practical solutions for making managed care better, The Managed Care Blues and How to Cure Them is a bold call for greater consumer protection, knowledge, and power in the health care arena.

The book contains black-and-white illustrations.

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Editorial Reviews

Doody's Review Service
Reviewer: Anna Maio, MD (Creighton University Medical Center)
Description: This book discusses the failure of our previous insurance system and the rise of managed care. The authors also present the negatives and positives of managed care and offer strategies to improve its quality.
Purpose: The purpose is to provide a candid and balanced assessment of managed care today.
Audience: This book is written for all who would like a candid and balanced view of managed care. The authors state, however, that the book is not written for those involved in health services research since most of the material would already be known to them. The authors bring different experiences to the book. Robert Berenson is a physician and Walter Zelman has been a political activist involved in insurance reform. They both participated in the failed Clinton Health Care Reform effort.
Features: Information is delivered in an organized format. An outline of the failure of our previous system and a discussion of its quality issues are followed by a detailed overview of managed care including its beginning, quality improvement, and cost issues. The final chapter offers 13 steps to raise the quality of managed care. A song title or phrase is the subtitle of each chapter and ties in well with the title of the book, in addition to increasing the reader's enjoyment. Any graphs or drawings are quite minimal and are few and far between.
Assessment: Since managed care is here to stay awhile, this book helps the reader to chase away the managed care blues. After reading the chapter on strategies to improve quality, I found myself more hopeful and better prepared to participate in the progress.
Healthplan
Timely...presents a well balanced review of the managed health care world as it actually exists....provides a fine resource for those who genuinely want, or need, to take a balanced review of managed health care...The authors provide a worthy service in elucidating, as clearly and articulately as one might hope, a fair discussion of issues in the industry
Anna Maio
This book discusses the failure of our previous insurance system and the rise of managed care. The authors also present the negatives and positives of managed care and offer strategies to improve its quality. The purpose is to provide a candid and balanced assessment of managed care today. This book is written for all who would like a candid and balanced view of managed care. The authors state, however, that the book is not written for those involved in health services research since most of the material would already be known to them. The authors bring different experiences to the book. Robert Berenson is a physician and Walter Zelman has been a political activist involved in insurance reform. They both participated in the failed Clinton Health Care Reform effort. Information is delivered in an organized format. An outline of the failure of our previous system and a discussion of its quality issues are followed by a detailed overview of managed care including its beginning, quality improvement, and cost issues. The final chapter offers 13 steps to raise the quality of managed care. A song title or phrase is the subtitle of each chapter and ties in well with the title of the book, in addition to increasing the reader's enjoyment. Any graphs or drawings are quite minimal and are few and far between. Since managed care is here to stay awhile, this book helps the reader to chase away the managed care blues. After reading the chapter on strategies to improve quality, I found myself more hopeful and better prepared to participate in the progress.
Booknews
Zelman (public health, Harvard) and Berenson (an official in the U.S. Department of Health and Human Services) attempt a clear-headed analysis of managed care, both its strengths and weaknesses. They argue that critics of the new system overly romanticize the old one, and disregard the considerable savings that are one result of the change. However, they also suggest needed reforms to improve quality of care and consumer empowerment under the managed care system. Paper edition (unseen), $17.95. Annotation c. by Book News, Inc., Portland, Or.

3 Stars from Doody
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Product Details

  • ISBN-13: 9780878406807
  • Publisher: Georgetown University Press
  • Publication date: 9/28/1998
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 224
  • Lexile: 1370L (what's this?)
  • Product dimensions: 5.90 (w) x 9.10 (h) x 0.60 (d)

Meet the Author

Walter A. Zelman is an instructor in health policy and management at the School of Public Health at Harvard University. He has served as a special deputy to the commissioner of the California Department of Insurance and as the California director of Common Cause, the public interest group.

Robert A. Berenson, MD, is currently director of the Center for Health Policy Plus and Providers in the Health Care Financing Administration, Department of Health and Human Services. He has practiced medicine for more than twenty years and was the founder and medical director of the National Capital Preferred Provider Organization.

Both authors have served as health policy advisors to the White House.

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Table of Contents

Preface
American Health Care: Yesterday, Today and Tomorrow 1
1 The Failure of the Old Insurance System 16
2 Quality in the Old System: Not What We Thought 35
3 The Rise of Managed Care 49
4 The Tools of Managed Care 64
5 The Cutting Edge of Quality Improvement 87
6 The Managed Care Backlash 102
7 The Managed Care Record: Better Than You Think 119
8 Rule of Price; Cult of Choice; Cost of Quality 137
9 Protecting the Floor 160
10 Thirteen Steps to Raising Quality in Managed Care 179
Epilogue 203
References 205
Index 213
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