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Institutions in the Managed Care Environment

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Healthcare Management

Part of the book series: Springer Texts in Business and Economics ((STBE))

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Abstract

Since “Wall Street discovered healthcare”, not only the age of peaceful coexistence between service providers and payers is over, but an entirely new consulting market has developed. However, the types of products differ widely. The products can be broken down into three categories. First, there are consultation products that are meant to increase the efficiency of the provision of services. Among these, the following are particularly relevant: Management service organisations (MSO), physician practice management companies (PPMC) and pharmacy benefit management organisations (PBM). The second type of consultation products concentrates on the individual managed care instruments. Therefore, consulting services have partially specialised in conducting utilization reviews or developing guidelines.

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Notes

  1. 1.

    The portion of the population registered with a health plan that has an external PBM.

  2. 2.

    The medicinal needs of the approx. 65 % working per cent of the American population are nearly always covered. Since 2006, Medicare policyholders also receive pharmaceutical coverage.

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Authors and Affiliations

  1. Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hanover, Germany

    Volker Eric Amelung

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  1. Volker Eric Amelung
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Amelung, V.E. (2013). Institutions in the Managed Care Environment. In: Healthcare Management. Springer Texts in Business and Economics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38712-8_7

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