Managed care penetration,insurance status,and access to health care

BACKGROUND: Access to health care, reflected by an ability to meet one's health needs, is influenced by individual characteristics and the environment. Although managed care activity influences healthcare prices and overall utilization, its relationship to access and its broader effects across different insurance categories has not been well studied. OBJECTIVE: To examine the association between managed care activity and individuals' access to care, and to assess differences in this relationship by insurance status. RESEARCH DESIGN: Cross-sectional survey of households conducted in 1998. SUBJECTS: A sample of 15,613 adult Ohio residents. MEASURES: Self-reported difficulties in obtaining health care, medications, supplies, or medical equipment in the past year. RESULTS: A total of 1248 (8.0%) identified an access problem. In bivariate analyses, these problems were more common among continuously and intermittently uninsured individuals compared with those who were continuously insured during the previous 12 months (P<0.001) and also among those living in areas with more managed care (P=0.01). After accounting for other individual and environmental characteristics in hierarchical analyses, individuals residing in areas with more managed care had 28% higher odds of reporting problems obtaining care than those elsewhere (multivariate odds ratio, 1.28; 95% confidence interval, 1.04-1.58]; P=0.02). No significant interaction between managed care penetration and insurance status was observed. CONCLUSIONS: Greater managed care activity is associated with unfavorable patterns of healthcare access despite an individual's insurance status, suggesting more pervasive effects. Unintended effects should be carefully evaluated when formulating future programs that seek to address disparities in access to care.     

Managed care: Moral conflicts for primary health care nurses

Nurses working within managed care systems often face moral conflicts. Ethical nursing practice seems to require justice with integrity, that is, treating persons in like circumstances similarly (formal justice); helping to shape public policy regarding the provision of health care benefits and burdens (distributive justice): discussing with patients the benefits that are and are not provided by particular insurance policies (contractual justice); and considering the issue of fairness relating to the pool of applicants of a particular insurance plan (contributive justice).     

Managed mental health care: problems and possibilities

Case management has become an established organizational approach to mental health care. However, a recent development of case management, known as 'managed care' has received only limited attention in the UK and this has been confined to acute medical or surgical hospital care. The potential of managed care as applied to mental health care is uncertain. This paper clarifies the nature of managed care and discusses its relevance to mental health care, in particular to the care of people suffering from schizophrenia. The high incidence and heavy resource demands of this user group makes these people an ideal focus for managed care. However, there are conceptual and practical problems hindering its development and implementation, including: the variability and unpredictability of the disease process of schizophrenia; challenges of outcome measurement; and problems relating to the current organization of mental health care.     

The home as a framework for health care

The past two or three decades have witnessed a steep rise in the cost of health and social services. It is anticipated that this uphill climb will continue and bring these systems to a complete collapse within a few decades. The prevention of this crisis depends on the elimination of some of the causes of the rise; (a) we do not want to save costs by sacrificing the quality of our services; (b) we have no control over the quantity of clients utilizing these services, or the seriousness of their problems; (c) we can, however, replace part of the expensive institutional care by the more natural and cost-effective home care, supplied by volunteers, strengthened by human and technological services. These principles guided an Israeli organization called Yad Sarah, whose leadership in the supply of home and community care enables thousands of ill, elderly and disabled people to remain at home, and thus save the high cost of institutionalization.     

Using the Mead model as a framework for nursing care.

A model of nursing has no valid purpose unless it serves nurses to help make their nursing better (Fawcett, 1989). The Mead model formed the basis for nursing care of Jason, a young patient who sustained a head injury, a puncture wound and lacerations to his face, in the study presented here. Examination of the Mead Model of nursing is followed by an account of why this model was used in preference to others as a framework for Jason's care. Three components of his nursing care--wound care, communication, involvement of relatives--are discussed in relation to both the model and current knowledge. It was concluded that as a structured way of planning and giving care, the Mead model lacks adequate guidelines. A less experienced nurse using the Mead model may overlook certain aspects of care, an experienced nurse may use his/her knowledge to give high standard care using research-based information. However, models need to be tested so they may be rejected or modified as guidelines for care in this case in the United Kingdom, within a welfare-orientated society.     

Primary health care: a framework for policy development

Primary health care has utility for policy development at all levels of organization in any nation, including policies influencing the health of persons living with severe and persistent mental illnesses. Using the primary health care framework, policies to improve health and housing for this population evolve from intersectoral collaboration. Active participation by those persons whose essential health is compromised by housing that is not acceptable, adequate, suitable, and affordable is required. Appropriate and affordable methods that address health challenges are identified. Access to services meeting essential health care needs of citizens has potential for healthy outcomes.     

Kaizen: a process improvement model for the business of health care and perioperative nursing professionals

Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement.