Managed Care Made Simple

The need for medical students, physicians, nurse practitioners, and other healthcare providers to understand managed care is greater now than ever. With clear explanations of issues ranging from medical costs to healthcare reform, Managed Care Made Simple is an invaluable resource for anyone who has chosen a career in the health professions. The second edition of this successful book updates the latest in this rapidly changing field. Every chapter has been revised and a new section on legislative initiatives has been added. Dr Baldor's straightforward approach offers a greater understanding of medical economics for physicians and their patients.

Robert A. Baldor is the author of Managed Care Made Simple, 2nd Edition, published by Wiley.

Preface to the First Edition

vii

(2)

Preface to the Second Edition

ix

(1)

Acknowledgments

x

(1)

Illustration Credits

xi

1. Introduction

1

(4)

2. Health-Care Financing

5

(14)

Overview

6

(2)

Traditional Indemnity Insurance and Fee for Service

8

(2)

Medicare

10

(5)

Medicaid

15

(2)

Payments

17

(2)

3. Health-Care Reform Initiatives

19

(16)

The Issues

20

(1)

The Reform Debate

21

(3)

The Current Situation

24

(1)

Examples of National Health-Care Systems

25

(5)

State Initiatives

30

(5)

4. Managed Care

35

(20)

Roots

36

(1)

Growth and Development

37

(2)

Organization Models

39

(2)

Functions

41

(6)

Workforce Issues

47

(1)

Payment Methods

48

(1)

Ethical Considerations

49

(3)

Legislative Initiatives

52

(3)

5. Health Insurance--The Patient's Perspective

55

(10)

Private Insurance

56

(1)

Medicare

57

(4)

Medicaid

61

(1)

Long-Term Care

62

(3)

6. Pharmaceutical Costs

65

(24)

7. Problem-Solving Exercises

89

(20)

Managed Care Exercise

90

(6)

Problem-Solving Cases

96

(13)

References

109

(4)

Glossary

113

(6)

Appendixes

119

(34)

A. Answers to Problem-Solving Cases

120

(24)

B. Board Review Questions

144

(3)

C. Hospital Costs

147

(1)

D. Diagnostic Imaging Charges

148

(1)

E. Clinical Pathology Diagnostic Test Costs

149

(1)

F. Miscellaneous Charges

150

(2)

G. Physician Fee for Selected Procedures

152

(1)

Index

153

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Managed Care Made Simple

Summary

Author Biography

Table of Contents

Supplemental Materials