Managed Care and Public Health

by Halverson, Paul K.; Kaluzny, Arnold D.; McLaughlin, Curtis P.; Mays, Glen P.

• ISBN13: 9780834208971
• ISBN10: 0834208970
• Format: Hardcover
• Copyright: 1998-06-01
• Publisher: Wolters Kluwer Law & Business

Summary

The must-have text for every student involved in managed care and public health. Managed Care and Public Health reveals the hottest trends and issues emerging among managed care and public health organizations, and examines a wide range of real-life partnerships with the private sector. Timely and practical, this textbook is ideal for public health students delving into the age of managed care. Features detailed case studies; chapters written by leading public health experts; discussion questions following each case study to enhance student understanding; plus an appendix with sample contracts for public and private collaborative agreements.

Table of Contents

Contributors	xiii	(4)
Foreword	xvii	(4)
Preface	xxi	(2)
Acknowledgments	xxiii
PART I CURRENT THEMES IN PUBLIC HEALTH AND MANAGED CARE	1	(102)
Chapter 1 Introduction	3	(8)
Paul K. Halverson
Glen P. Mays
Arnold D. Kaluzny
Opportunities for Managed Care and Public Health	4	(1)
Challenges for Public Health and Managed Care	5	(4)
Conclusion	9	(2)
Chapter 2 Current Practice and Evolving Roles in Public Health	11	(31)
Paul K. Halverson
Donald R. Haley
Glen P. Mays
Background	11	(2)
Organization of Public Health	13	(19)
Role of Public Health	32	(1)
New Developments in Public Health Practice	33	(6)
Conclusion	39	(3)
Chapter 3 Managed Care and Its Relationship to Public Health: Barriers and Opportunities	42	(31)
Curtis P. McLaughlin
Managed Care in the Public Sector	43	(1)
History of Health Care Financing	43	(5)
Stages of Managed Care Market Maturity	48	(1)
The Limited Role of Health Departments	48	(1)
Access, Cost, and Quality under Managed Care	49	(3)
A Sample Contract: The Case of North Carolina	52	(2)
The Vocabulary of Managed Care	54	(1)
Mapping the Relationship of Managed Care and Public Health	54	(4)
Legislative Responses	58	(3)
Prevention and Managed Care	61	(2)
Barriers to Prevention	63	(1)
Individual Provider Disinterest	63	(1)
Time Value of Prevention	63	(5)
Disenrollment	68	(1)
Lack of Integration	68	(1)
Conclusion	69	(4)
Chapter 4 Privatization of Public Hospitals: Trends and Strategies	73	(10)
Montague Brown
Background	73	(1)
Privatization Takes Many Forms	74	(1)
Reasons for Transformation	75	(1)
Broad and Accelerating Trends	76	(1)
Key Concerns for Privatization: Source of Decision Criteria	77	(4)
Conclusion	81	(2)
Chapter 5 Privatization and Health Care	83	(20)
Curtis P. McLaughlin
Privatization Alternatives	84	(2)
Alternative Control Mechanisms	86	(3)
Maintaining Accountability	89	(1)
Why Privatize?	90	(1)
Why Choose To Go For-Profit?	91	(3)
Alliances	94	(3)
TennCare	97	(3)
Conclusion	100	(3)
PART II APPLICATIONS OF MANAGED CARE AND PRIVATIZATION	103	(80)
Chapter 6 Managed Care for Medicaid Beneficiaries: An Overview	105	(20)
Robert E. Hurley
Debra A. Draper
Background	106	(7)
Current Issues and Developments	113	(4)
The Broader Context of Medicaid Managed Care	117	(3)
Key Questions and Concerns	120	(3)
Conclusion	123	(2)
Chapter 7 Privatizing Maternal and Child Health Services in Texas	125	(12)
Patti J. Patterson
J. Scott Simpson
Robbie J. Davis
Debra C. Stabeno
Linda L. Bultman
Background	126	(2)
Reinventing Title V Programs	128	(3)
The Prospects of Title V Redesign: Challenges and Opportunities	131	(4)
Conclusion	135	(2)
Chapter 8 Public and Private Sector Involvement in Managed Mental Health Care	137	(20)
Bruce J. Fried
Matthew C. Johnsen
Artemis H. Malekpour
A Historical View of Public and Private Participation in Mental Health Services	138	(10)
Managed Mental Health Care in the Public Sector	148	(4)
Unanswered Questions about Privatization of Mental Health Services	152	(5)
Chapter 9 Managed Care and the Delivery of Public Mental Health and Substance Abuse Services	157	(14)
Mady Chalk
Managed Care for Mental Health and Substance Abuse Treatment	157	(2)
Key Issues, Opportunities, and Challenges for Quality Management	159	(3)
Policy Implications for Quality Management	162	(7)
Conclusion	169	(2)
Chapter 10 The Privatization of Quality Assurance in Health Care	171	(12)
Gary J. Young
Public Oversight of Quality	172	(1)
The Role of the Private Sector in Public Quality Assurance Programs	173	(1)
Expansion of the Private Sector Role in External Quality Assurance	174	(2)
Privatization of External Quality Assurance: Theoretical Issues	176	(3)
The Future Role of the Public Sector in External Quality Assurance	179	(1)
Conclusion	180	(3)
PART III CASE STUDIES IN PUBLIC HEALTH AND MANAGED CARE	183	(138)
Chapter 11 Managed Care, Public Health, and Privatization: A Typology of Interorganizational Arrangements	185	(16)
Glen P. Mays
Paul K. Halverson
Arnold D. Kaluzny
Models of Interaction Between Managed Care and Public Health	185	(14)
Conclusion	199	(2)
Chapter 12 Case Study: Integrated Public and Private Health Care Systems in Denver, CO	201	(21)
Glen P. Mays
Overview of the Community	201	(4)
Managed Care in the Public Health System	205	(5)
Public Health in the Private Health Care Market	210	(9)
Conclusion	219	(1)
Discussion Questions	220	(2)
Chapter 13 Case Study: Group Health Cooperative and the Public Health System Serving Olympia, WA	222	(11)
Curtis P. McLaughlin
Paul K. Halverson
Glen P. Mays
Overview of the Community	223	(1)
History of Group Health Cooperative	223	(1)
Utilization Management and Quality Improvement	224	(2)
Population-Based Health Care	226	(1)
Medicaid Managed Care	227	(1)
Health Services Research	228	(1)
Interaction with the Local Health Department	229	(2)
Conclusion	231	(1)
Discussion Questions	231	(2)
Chapter 14 Case Study: A Public Sector HMO in Portland, OR	233	(10)
Glen P. Mays
Overview of the Community	233	(2)
Overview of the Public Health System	235	(1)
History of Managed Care in the Public Health System	235	(2)
Current Challenges and Opportunities	237	(3)
Conclusion	240	(1)
Discussion Questions	241	(2)
Chapter 15 Case Study: Reconfiguring Memphis' Public Health System for Managed Care	243	(9)
Glen P. Mays
Overview of the Community	243	(2)
Managed Care and the Public Health System	245	(3)
Current Challenges and Opportunities	248	(1)
Conclusion	249	(1)
Discussion Questions	250	(2)
Chapter 16 Case Study: The Local Health Department's Role in Milwaukee's Managed Care Market	252	(9)
Glen P. Mays
Overview of the Community	252	(2)
The Public Health System's Role in Managed Care	254	(2)
The Private Sector's Role in Public Health	256	(3)
Conclusion	259	(1)
Discussion Questions	260	(1)
Chapter 17 Case Study: Privatizing a Community Hospital in Rocky Mount, NC	261	(16)
Curtis P. McLaughlin
Rocky Mount and Nash County	262	(1)
The New Lease Proposal	263	(5)
The Alternative Lease	268	(1)
The Counter-Offer	269	(3)
Recent Development	272	(3)
Conclusion	275	(1)
Discussion Questions	275	(2)
Chapter 18 Case Study: Providing Public Health Services through an Integrated Delivery System in Mecklenburg Country, NC	277	(11)
Stephen R. Keener
John W. Baker
Glen P. Mays
Rationale and History	278	(1)
Structure and Operation	279	(2)
Existing Approaches to Quality Management	281	(3)
Remaining Challenges for Quality Management	284	(2)
Conclusion	286	(1)
Discussion Questions	286	(2)
Chapter 19 Case Study: Hospital Privatization as a Quality Improvement Strategy in Jersey City, NJ	288	(13)
Jonathan M. Metsch
Donald R. Haley
Donald Malafronte
Privatization: Purpose and Process	289	(5)
Lessons Learned from Privatization of Health Care Delivery Systems	294	(4)
Conclusion	298	(1)
Discussion Questions	299	(2)
Chapter 20 Case Study: Privatizing the Mental Health System in King County, WA	301	(20)
Anne Y. Ilinitch
Curtis P. McLaughlin
The Title XIX Waiver	302	(1)
Authorization To Pursue Becoming a Prepaid Health Plan	302	(1)
Mental Health Activities in King County	303	(1)
Mental Health Categorization	303	(4)
The Current KCRSN Fee-for-Service Process	307	(1)
Decision To Have a Prepaid Health Plan in King Country	308	(3)
Implementation Problems	311	(1)
Privatization Options	312	(1)
Provider Agencies	312	(1)
Peregrine-Northwest	313	(3)
The Role of the State DSHS	316	(1)
Peregrine's Dilemma	317	(1)
Peregrine's Choices	318	(1)
Conclusion	318	(1)
Discussion Questions	319	(2)
PART IV MANAGING THE PUBLIC'S HEALTH: POLICY IMPLICATIONS AND CONCLUSIONS	321	(44)
Chapter 21 Ensuring Quality and Access under Managed Care	323	(16)
Pam Silberman
The Challenges of Managed Care	323	(2)
Mechanisms To Ensure Access and Quality	325	(3)
How Well Do Oversight Mechanisms Protect Consumer Interests in Quality, Access, and Health Status Improvement?	328	(4)
Where Do We Go from Here?	332	(7)
Chapter 22 Public Health, Privatization, and Market Populism: A Cautionary Note	339	(11)
Dan Beauchamp
The Market and Democracy	340	(1)
Market Populism	341	(2)
Public Health as a Prophetic Voice	343	(2)
Public Health as a Voice for the Community	345	(5)
Chapter 23 Strategies for Managing the Public's Health: Implications and Next Steps	350	(15)
Paul K. Halverson
Arnold D. Kaluzny
Curtis P. McLaughlin
The New Frontier	351	(1)
Implications of Privatization	352	(5)
Next Steps	357	(4)
Conclusion	361	(4)
Appendix A Medicaid Managed Care Risk Contract Between the State of North Carolina, Division of Medical Assistance, and a Health Maintenance Organization	365	(68)
Appendix B Sample Contract Between a Local Health Department and a Health Maintenance Organization	433	(20)
Index	453