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| 020 | |a 3662595672 |9 3-662-59567-2 | ||
| 024 | 3 | |a 9783662595671 | |
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| 245 | 1 | 0 | |a Healthcare management |b managed care organisations and instruments |c Volker Eric Amelung ; with collaboration of Charity M. Agbor, Mirella Cacace, Axel Mühlbacher, Ulla Tangermann, Anika Meißner, Andreas Domdey, Christian Krauth, Susanne Bethge, Peter Berchtold, and Christoph Wagner |
| 250 | |a Second edition | ||
| 264 | 1 | |a Berlin |b Springer |c [2019] | |
| 300 | |a xix, 261 Seiten |b Illustrationen, Diagramme |c 23.5 cm x 15.5 cm | ||
| 336 | |b txt |2 rdacontent | ||
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| 700 | 1 | |a Amelung, Volker E. |d 1965- |0 (DE-588)13051571X |4 edt |4 aut | |
| 700 | 1 | |a Agbor, Charity M. |4 ctb | |
| 700 | 1 | |a Cacace, Mirella |0 (DE-588)1190683660 |4 ctb | |
| 700 | 1 | |a Mühlbacher, Axel |d 1970- |0 (DE-588)123505321 |4 ctb | |
| 700 | 1 | |a Tangermann, Ulla |d 1985- |0 (DE-588)1142150097 |4 ctb | |
| 700 | 1 | |a Meißner, Anika |4 ctb | |
| 700 | 1 | |a Domdey, Andreas |0 (DE-588)1190760088 |4 ctb | |
| 700 | 1 | |a Krauth, Christian |d 1962- |0 (DE-588)114610088 |4 ctb | |
| 700 | 1 | |a Bethge, Susanne |d 1981- |0 (DE-588)1097416062 |4 ctb | |
| 700 | 1 | |a Berchtold, Peter |d 1954- |0 (DE-588)121755673 |4 ctb | |
| 700 | 1 | |a Wagner, Christoph Johann |4 ctb | |
| 710 | 2 | |a Springer-Verlag GmbH |0 (DE-588)1065168780 |4 pbl | |
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| 776 | 0 | |z 9783662595688 |c eBook | |
| 776 | 0 | |z 9783662595701 | |
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Record in the Search Index
| _version_ | 1820962648775196672 |
|---|---|
| adam_text |
CONTENTS
PART
I
BASIC
IDEAS
OF
MANAGED
CARE
1
DEFINITIONS
AND
CONCEPTS
.
3
1.1
SUPPORTING
AND
INHIBITING
FACTORS
OF
MANAGED
CARE
.
3
1.2
DEFINITIONS
OF
MANAGED
CARE
.
6
1.3
WHICH
INSTRUMENTS
AND
ORGANISATIONAL
FORMS
BELONG
TO
MANAGED
CARE?
.
9
1.4
WHAT
CHANGES
FOR
THOSE
INVOLVED
IN
THE
MANAGED
CARE
CONTEXT?
.
11
LITERATURE
.
13
2
MAIN
CHARACTERISTICS
OF
THE
AMERICAN
HEALTHCARE
SYSTEM
.
17
2.1
FUNDING
HEALTHCARE
.
17
2.1.1
GOVERNMENT
AND
COMPULSORY
CONTRIBUTION
SCHEMES
.
18
2.1.2
PRIVATE
HEALTHCARE
COVERAGE
PLANS
.
20
2.2
DELIVERING
HEALTHCARE
SERVICES
.
22
2.3
RECEIVING
HEALTHCARE
SERVICES
.
23
LITERATURE
.
24
3
THEORETICAL
CONCEPTS
FOR
THE
ASSESSMENT
OF
MANAGED
CARE
.
27
3.1
TRANSACTION
COST
THEORY
.
27
3.1.1
FUNDAMENTAL
IDEAS
.
27
3.1.2
TRANSACTION
COSTS
.
28
3.2
REASONS
FOR
MARKET
FAILURE:
WILLIAMSON
*
S
ORGANISATIONAL
FAILURE
FRAMEWORK
OF
1975
.
29
3.2.1
MARKET,
HIERARCHY
OR
COOPERATIONS
.
31
3.2.2
THE
SUITABILITY
OF
TRANSACTION
COST
THEORY
IN
HEALTHCARE
.
32
3.3
PRINCIPAL-AGENT
THEORY
.
33
3.4
INFORMATION
ASYMMETRIES
AND
BEHAVIOURAL
UNCERTAINTIES
.
35
3.4.1
COORDINATION
PATTERNS
.
37
3.4.2
PRINCIPAL-AGENT
THEORY
FOR
THE
ANALYSIS
OF
STEERING
ELEMENTS
IN
HEALTHCARE
.
40
LITERATURE
.
40
XII
CONTENTS
PART
II
MANAGED
CARE
ORGANISATIONS
AND
PRODUCTS
4
PRELIMINARY
REMARKS
.
45
LITERATURE
.
48
5
INSURANCE-BASED
MANAGED
CARE
ORGANISATIONS
AND
PRODUCTS
. 49
5.1
STAFF,
GROUP,
IPA
AND
NETWORK
MODEL
HMOS
.
49
5.1.1
BASIC
IDEA
.
49
5.1.2
STAFF
MODEL
HMOS
.
51
5.1.3
GROUP
MODEL
HMOS
.
53
5.1.4
IPA
MODEL
HMOS
.
58
5.1.5
NETWORK
MODEL
HMOS
.
58
5.2
CONSUMER-DRIVEN
HEALTH
PLANS
(CDHPS)
AND
HEALTH
SAVINGS
ACCOUNTS
.
60
5.2.1
GUIDELINES
AND
HEALTH
POLICY
GOALS
.
60
5.2.2
FORMS
AND
PREVALENCE
.
61
5.2.3
ASSESSMENT
.
63
LITERATURE
.
64
6
PROVIDER-BASED
MANAGED
CARE
ORGANISATIONS
AND
PRODUCTS
.
67
6.1
INDEPENDENT
PRACTICE
ASSOCIATIONS
(IPA)
.
67
6.2
PREFERRED
PROVIDER
ORGANISATIONS
(PPO)
.
68
6.3
NETWORKS
.
69
6.4
INTEGRATED
DELIVERY
SYSTEMS
(IDS)
.
72
6.5
ACCOUNTABLE
CARE
ORGANISATIONS
(ACO)
.
80
6.6
PATIENT-CENTRED
MEDICAL
HOMES
(PCMH)
.
81
LITERATURE
.
83
7
INSTITUTIONS
IN
THE
MANAGED
CARE
ENVIRONMENT
.
87
7.1
MANAGEMENT
SERVICE
ORGANISATIONS
(MSO)
.
87
7.2
PHYSICIAN
PRACTICE
MANAGEMENT
COMPANIES
(PPMC)
.
89
7.3
PHARMACY
BENEFIT
MANAGEMENT
(PBM)
.
90
7.3.1
ELEMENTS
OF
PHARMACY
BENEFIT
MANAGEMENT
(PBM)
.
91
7.3.2
ASSESSMENT
.
94
LITERATURE
.
94
8
CONCLUSION
.
97
LITERATURE
.
99
PART
III
MANAGED
CARE
INSTRUMENTS
9
CONTRACT
DESIGN
.
103
9.1
SELECTIVE
CONTRACTING
.
103
9.1.1
INTRODUCTORY
REMARKS
.
103
9.1.2
SELECTIVE
CONTRACTS
WITH
PHYSICIANS
.
104
9.1.3
SELECTIVE
CONTRACTS
WITH
HOSPITALS
.
106
9.1.4
ASSESSMENT
OF
SELECTIVE
CONTRACTING
.
107
CONTENTS
XIII
9.2
STRUCTURING
THE
INSURANCE
CONTRACTS
.
108
9.2.1
BASIC
CONCEPTS
.
108
9.2.2
OPTIONS
FOR
MANAGING
PRE-CONTRACT
RISKS
.
108
9.2.3
OPTIONS
FOR
MANAGING
POST-CONTRACT
RISKS
.
109
9.2.4
ASSESSMENT
.
115
LITERATURE
.
116
10
COMPENSATION
SYSTEMS
.
119
10.1
FOUNDATION
.
119
10.2
FORMS
OF
COMPENSATION
.
122
10.2.1
SALARY
.
123
10.2.2
FACTOR
COST
REIMBURSEMENT
.
123
10.2.3
FEE-FOR-SERVICE
.
124
10.2.4
DAILY
RATES
(PER
DIEM)
.
125
10.2.5
CASE
RATES
AND
DIAGNOSIS
RELATED
GROUPS
(DRGS)
.
126
10.2.6
BUNDLED
PAYMENTS
.
128
10.2.7
CAPITATION
.
131
10.3
PAY-FOR-PERFORMANCE
(P4P)
AND
PUBLIC
REPORTING
.
133
10.3.1
PAY-FOR-PERFORMANCE
.
133
10.3.2
DESIGN
OF
THE
MODEL
.
135
10.3.3
PUBLIC
REPORTING
.
139
10.3.4
BASIC
PRINCIPLE
.
139
10.3.5
NEGATIVE
INCENTIVES
.
141
10.4
CONCLUSION
.
142
LITERATURE
.
143
11
QUALITY
MANAGEMENT
.
149
11.1
GUIDELINES
AND
CLINICAL
PATHWAYS
.
149
11.1.1
BASIC
CONCEPTS
.
149
11.1.2
FORMS
AND
OBJECTIVES
OF
GUIDELINES
.
151
11.1.3
AREAS
OF
APPLICATION
FOR
GUIDELINES
.
152
11.1.4
ASSESSMENT
.
153
11.2
DISEASE
MANAGEMENT
AND
CHRONIC
CARE
.
156
11.2.1
INTRODUCTORY
REMARKS
.
156
11.2.2
ELEMENTS
OF
DISEASE
MANAGEMENT
.
157
11.2.3
STAGES
OF
DISEASE
MANAGEMENT
.
158
11.2.4
CHRONIC
CARE
MODEL
.
161
11.2.5
CRITICAL
ASSESSMENT
OF
DISEASE
MANAGEMENT
AND
CHRONIC
CARE
MANAGEMENT
.
164
11.3
CASE
MANAGEMENT
.
166
11.3.1
INTRODUCTION
.
166
11.3.2
RANGE
OF
TASKS
OF
THE
CASE
MANAGER
.
168
11.3.3
CASE
MANAGEMENT
PROCEDURE
.
170
11.3.4
EVALUATING
CASE
MANAGEMENT
.
171
11.4
PATIENT
COACHING
.
172
XIV
CONTENTS
11.4.1
SPECIFICATIONS
OF
PATIENT
COACHING
.
173
11.4.2
ASSESSMENT
.
176
11.5
PRINCIPLES
OF
MANAGED
CARE
.
177
11.5.1
PRELIMINARY
REMARKS
.
177
11.5.2
QUALITY
PLANNING
(
*
PLAN
*
)
.
178
11.5.3
QUALITY
IMPLEMENTATION
(
*
DO
*
)
.
183
11.5.4
QUALITY
INSPECTION
(
*
CHECK
*
)
.
183
11.5.5
IMPLEMENTATION
OF
QUALITY
IMPROVEMENT
MEASURES
(*
ACT
*
)
.
186
11.5.6
ASSESSMENT
.
186
LITERATURE
.
187
12
COST
MANAGEMENT
.
195
12.1
GATEKEEPING
.
195
12.1.1
BASIC
IDEA
.
195
12.1.2
FORMS
OF
GATEKEEPING
.
196
12.1.3
SIGNIFICANCE
AND
MECHANISMS
.
197
12.1.4
ASSESSMENT
.
198
12.2
FORMULARIES
.
199
12.2.1
FUNDAMENTAL
CONCEPTS
AND
EFFECTIVE
MECHANISMS
.
.
.
.
199
12.2.2
GOALS
OF
IMPLEMENTING
FORMULARIES
.
201
12.2.3
ASSESSMENT
.
202
12.3
UTILISATION
REVIEW
AND
MANAGEMENT
.
203
12.3.1
BASIC
CONCEPTS
.
204
12.3.2
FORMS
OF
UTILISATION
REVIEW
AND
UTILISATION
MANAGEMENT
.
205
12.3.3
IMPORTANCE
AND
EFFECTIVE
MECHANISMS
.
207
12.3.4
ASSESSMENT
.
208
LITERATURE
.
209
13
EVALUATION
PROCEDURE
.
213
13.1
OVERVIEW
.
213
13.2
HEALTH
ECONOMIC
EVALUATION
.
214
13.2.1
COST
ANALYSIS
.
215
13.2.2
COST-EFFECTIVENESS
ANALYSIS
.
216
13.2.3
COST-UTILITY
ANALYSIS
.
217
13.2.4
COST-BENEFIT
ANALYSIS
.
219
13.2.5
SENSITIVITY
ANALYSIS
.
220
13.3
PREFERENCE
MEASUREMENT
.
221
13.3.1
PATIENT
BENEFITS
AND
PREFERENCES
.
221
13.3.2
MEASUREMENT
OF
PREFERENCES
.
222
13.3.3
THE
FOUNDATIONAL
METHODS:
THE
CONJOINT
ANALYSIS
(CA)
.
223
13.3.4
THE
DISCRETE
CHOICE
EXPERIMENT
.
223
13.3.5
ASSESSMENT
.
227
CONTENTS
XV
13.4
EVIDENCE-BASED
MEDICINE
(EBM)
.
228
13.4.1
SYSTEMATIC
ACQUISITION
OF
INFORMATION
.
229
13.4.2
ANALYSIS
OF
THE
EVIDENCE
.
230
13.4.3
APPLICATION
OF
EVIDENCE
FOUND
IN
INDIVIDUAL
CASES
.
.
.
230
13.5
HEALTH
SERVICES
RESEARCH
.
231
13.6
HEALTH
TECHNOLOGY
ASSESSMENT
(HTA)
.
233
LITERATURE
.
235
PART
IV
EVALUATION
OF
MANAGED
CARE
14
PRELIMINARY
REMARKS
.
241
LITERATURE
.
242
15
COST
EFFECTS
OF
MANAGED
CARE
.
245
LITERATURE
.
246
16
QUALITY
EFFECTS
OF
MANAGED
CARE
.
247
LITERATURE
.
249
17
ACCESS
EFFECTS
OF
MANAGED
CARE
.
251
LITERATURE
.
252
18
ACCEPTANCE
OF
MANAGED
CARE
.
253
18.1
ACCEPTANCE
FROM
THE
INSURED
AND
PATIENTS
.
253
18.2
ACCEPTANCE
FROM
PHYSICIANS
.
254
LITERATURE
.
254
19
CONCLUSION
.
257
LITERATURE
.
258
INDEX
.
259 |
| any_adam_object | 1 |
| author | Amelung, Volker E. 1965- |
| author2 | Amelung, Volker E. 1965- Agbor, Charity M. Cacace, Mirella Mühlbacher, Axel 1970- Tangermann, Ulla 1985- Meißner, Anika Domdey, Andreas Krauth, Christian 1962- Bethge, Susanne 1981- Berchtold, Peter 1954- Wagner, Christoph Johann |
| author2_role | edt ctb ctb ctb ctb ctb ctb ctb ctb ctb ctb |
| author2_variant | v e a ve vea c m a cm cma m c mc a m am u t ut a m am a d ad c k ck s b sb p b pb c j w cj cjw |
| author_GND | (DE-588)13051571X (DE-588)1190683660 (DE-588)123505321 (DE-588)1142150097 (DE-588)1190760088 (DE-588)114610088 (DE-588)1097416062 (DE-588)121755673 |
| author_facet | Amelung, Volker E. 1965- Amelung, Volker E. 1965- Agbor, Charity M. Cacace, Mirella Mühlbacher, Axel 1970- Tangermann, Ulla 1985- Meißner, Anika Domdey, Andreas Krauth, Christian 1962- Bethge, Susanne 1981- Berchtold, Peter 1954- Wagner, Christoph Johann |
| author_role | aut |
| author_sort | Amelung, Volker E. 1965- |
| author_variant | v e a ve vea |
| building | Verbundindex |
| bvnumber | BV046244879 |
| classification_rvk | QX 700 XC 5400 |
| ctrlnum | (OCoLC)1102308443 (DE-599)DNB1186399422 |
| dewey-full | 650 |
| dewey-hundreds | 600 - Technology (Applied sciences) |
| dewey-ones | 650 - Management and auxiliary services |
| dewey-raw | 650 |
| dewey-search | 650 |
| dewey-sort | 3650 |
| dewey-tens | 650 - Management and auxiliary services |
| discipline | Wirtschaftswissenschaften Medizin |
| edition | Second edition |
| format | Book |
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| geographic | USA (DE-588)4078704-7 gnd |
| geographic_facet | USA |
| id | DE-604.BV046244879 |
| illustrated | Illustrated |
| indexdate | 2025-01-11T14:21:48Z |
| institution | BVB |
| institution_GND | (DE-588)1065168780 |
| isbn | 9783662595671 3662595672 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-031623215 |
| oclc_num | 1102308443 |
| open_access_boolean | |
| owner | DE-384 DE-1050 |
| owner_facet | DE-384 DE-1050 |
| physical | xix, 261 Seiten Illustrationen, Diagramme 23.5 cm x 15.5 cm |
| publishDate | 2019 |
| publishDateSearch | 2019 |
| publishDateSort | 2019 |
| publisher | Springer |
| record_format | marc |
| series2 | Springer texts in business and economics |
| spelling | Healthcare management managed care organisations and instruments Volker Eric Amelung ; with collaboration of Charity M. Agbor, Mirella Cacace, Axel Mühlbacher, Ulla Tangermann, Anika Meißner, Andreas Domdey, Christian Krauth, Susanne Bethge, Peter Berchtold, and Christoph Wagner Second edition Berlin Springer [2019] xix, 261 Seiten Illustrationen, Diagramme 23.5 cm x 15.5 cm txt rdacontent n rdamedia nc rdacarrier Springer texts in business and economics Managed Care (DE-588)4461436-6 gnd rswk-swf Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Organisation (DE-588)4043774-7 gnd rswk-swf USA (DE-588)4078704-7 gnd rswk-swf USA (DE-588)4078704-7 g Gesundheitswesen (DE-588)4020775-4 s Organisation (DE-588)4043774-7 s Managed Care (DE-588)4461436-6 s DE-604 Amelung, Volker E. 1965- (DE-588)13051571X edt aut Agbor, Charity M. ctb Cacace, Mirella (DE-588)1190683660 ctb Mühlbacher, Axel 1970- (DE-588)123505321 ctb Tangermann, Ulla 1985- (DE-588)1142150097 ctb Meißner, Anika ctb Domdey, Andreas (DE-588)1190760088 ctb Krauth, Christian 1962- (DE-588)114610088 ctb Bethge, Susanne 1981- (DE-588)1097416062 ctb Berchtold, Peter 1954- (DE-588)121755673 ctb Wagner, Christoph Johann ctb Springer-Verlag GmbH (DE-588)1065168780 pbl Erscheint auch als Online-Ausgabe 10.1007/978-3-662-59568-8 9783662595688 eBook 9783662595701 Erscheint auch als Online-Ausgabe 978-3-662-59568-8 X: MVB text/html http://deposit.dnb.de/cgi-bin/dokserv?id=25406a7e87b64a71b86c241b89bd9463&prov=M&dok_var=1&dok_ext=htm 2019-05-22 Verlag Inhaltstext DNB Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=031623215&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis SWB Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=031623215&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Buchcover |
| spellingShingle | Amelung, Volker E. 1965- Healthcare management managed care organisations and instruments Managed Care (DE-588)4461436-6 gnd Gesundheitswesen (DE-588)4020775-4 gnd Organisation (DE-588)4043774-7 gnd |
| subject_GND | (DE-588)4461436-6 (DE-588)4020775-4 (DE-588)4043774-7 (DE-588)4078704-7 |
| title | Healthcare management managed care organisations and instruments |
| title_auth | Healthcare management managed care organisations and instruments |
| title_exact_search | Healthcare management managed care organisations and instruments |
| title_full | Healthcare management managed care organisations and instruments Volker Eric Amelung ; with collaboration of Charity M. Agbor, Mirella Cacace, Axel Mühlbacher, Ulla Tangermann, Anika Meißner, Andreas Domdey, Christian Krauth, Susanne Bethge, Peter Berchtold, and Christoph Wagner |
| title_fullStr | Healthcare management managed care organisations and instruments Volker Eric Amelung ; with collaboration of Charity M. Agbor, Mirella Cacace, Axel Mühlbacher, Ulla Tangermann, Anika Meißner, Andreas Domdey, Christian Krauth, Susanne Bethge, Peter Berchtold, and Christoph Wagner |
| title_full_unstemmed | Healthcare management managed care organisations and instruments Volker Eric Amelung ; with collaboration of Charity M. Agbor, Mirella Cacace, Axel Mühlbacher, Ulla Tangermann, Anika Meißner, Andreas Domdey, Christian Krauth, Susanne Bethge, Peter Berchtold, and Christoph Wagner |
| title_short | Healthcare management |
| title_sort | healthcare management managed care organisations and instruments |
| title_sub | managed care organisations and instruments |
| topic | Managed Care (DE-588)4461436-6 gnd Gesundheitswesen (DE-588)4020775-4 gnd Organisation (DE-588)4043774-7 gnd |
| topic_facet | Managed Care Gesundheitswesen Organisation USA |
| url | http://deposit.dnb.de/cgi-bin/dokserv?id=25406a7e87b64a71b86c241b89bd9463&prov=M&dok_var=1&dok_ext=htm http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=031623215&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=031623215&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA |
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