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Gatekeepers and Sentinels

  • Robert B. Smith
Chapter

Abstract

By applying a basic fixed- and random-effects paradigm of meta-analysis, this chapter summarizes findings from numerous evaluations of managed care programs in which nurses preauthorized and monitored inpatient care. Although the backlash against managed care circa 2000 reduced the use of such programs, the rising costs of medical care have led health plans to reconsider their use (Mays et al. 2004, W4: 429–431). So that Medicare can meet the future needs of the retiring baby boom generation, the National Academy of Social Insurance formed panels of experts to develop recommendations about reforming Medicare (Aaron and Reischauer 1995, 1998; Marmor and Oberlander 1998; Wilensky and Newhouse 1999). The panel on fee-for-service Medicare (January 1998) requested the identification of promising private-sector innovations for managing health care costs and quality that Medicare could apply (Fox 1997, 50; Miller and Luft 1997).

Keywords

Obstetrical Complication Program Effect Ancillary Service Medical Necessity Conventional Program 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The author thanks Dr. Greta Ljung for explicating aspects of the fixed- and random-effects statistical models and for her collaboration and editorial critique of early versions of this chapter. He also thanks the following people for sharing their knowledge with him: Duane Hayes of the SAS Institute clarified aspects of Poisson regression analysis; Dr. Thomas E. Gotowka critiqued the original reports; Dr. Rezaul Khandker, Dr. Sharon Fox, and Dr. Joanna Handlin Smith critiqued drafts of the article on which the present chapter is based; Ms. Janet Moroney and Mr. Christopher G. Richards of the Massachusetts Peer Review Organization (MassPRO) clarified how PROs control the costs and quality of Medicare. Earlier versions of this chapter were presented at the 1996 Joint Statistical Meetings in Chicago, August 4–8, 1996 and at the Conference in Honor of Clifford Clogg, Pennsylvania State University, September 26–28, 1996. Main portions of this chapter were published in the Evaluation Review (vol. 25, no. 3, 228–330; © 2001 Sage Publications). The author thanks the publisher for allowing him to reuse this material in this book. The views expressed herein are the author’s own and do not necessarily reflect those of any colleagues or organizations.

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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Social Structural Research Inc.CambridgeUSA

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