Chapter 27 - Managed care

Question 1

What is managed care

Answer 1

It is to maintain the affordability of healthcare by ensuring its cost-effectiveness

Question 2

Give exapmles of managed care programmes and the types of protocols that could be applied under each

Answer 2

• Medicine risk management - a restrictive formulary governing which medicines may be used for certain conditions
• Maternity programme - only allow c-sections when these are deemed clinically necessary by a healthcare provider
• Specialist and GP networks - restricting access to a selected network of specialist and GPs, with whom preferential charging structures have been agreed

Question 3

What are the main objectives of managed care interventions

Answer 3

HIM RN

• Ensuring that HIGH-risk members are managed and receive appropriate care
• IMPROVING the quality of care provided
• Ensuring that MEDICAL services are delivered in an appropriate setting
• REDUCING the cost of medical events
• Reducing the NUMBER of unnecessary medical services