Managed Care and Public Health

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

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ISBN: 9780834208971 | 0834208970
Cover: Hardcover
Copyright: 6/1/1998

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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.

Contributors

xiii

(4)

Foreword

xvii

(4)

Preface

xxi

(2)

Acknowledgments

xxiii

PART I CURRENT THEMES IN PUBLIC HEALTH AND MANAGED CARE

(102)

Chapter 1 Introduction

(8)

Paul K. Halverson

Glen P. Mays

Arnold D. Kaluzny

Opportunities for Managed Care and Public Health

(1)

Challenges for Public Health and Managed Care

(4)

Conclusion

(2)

Chapter 2 Current Practice and Evolving Roles in Public Health

(31)

Paul K. Halverson

Donald R. Haley

Glen P. Mays

Background

(2)

Organization of Public Health

(19)

Role of Public Health

(1)

New Developments in Public Health Practice

(6)

Conclusion

(3)

Chapter 3 Managed Care and Its Relationship to Public Health: Barriers and Opportunities

(31)

Curtis P. McLaughlin

Managed Care in the Public Sector

(1)

History of Health Care Financing

(5)

Stages of Managed Care Market Maturity

(1)

The Limited Role of Health Departments

(1)

Access, Cost, and Quality under Managed Care

(3)

A Sample Contract: The Case of North Carolina

(2)

The Vocabulary of Managed Care

(1)

Mapping the Relationship of Managed Care and Public Health

(4)

Legislative Responses

(3)

Prevention and Managed Care

(2)

Barriers to Prevention

(1)

Individual Provider Disinterest

(1)

Time Value of Prevention

(5)

Disenrollment

(1)

Lack of Integration

(1)

Conclusion

(4)

Chapter 4 Privatization of Public Hospitals: Trends and Strategies

(10)

Montague Brown

Background

(1)

Privatization Takes Many Forms

(1)

Reasons for Transformation

(1)

Broad and Accelerating Trends

(1)

Key Concerns for Privatization: Source of Decision Criteria

(4)

Conclusion

(2)

Chapter 5 Privatization and Health Care

(20)

Curtis P. McLaughlin

Privatization Alternatives

(2)

Alternative Control Mechanisms

(3)

Maintaining Accountability

(1)

Why Privatize?

(1)

Why Choose To Go For-Profit?

(3)

Alliances

(3)

TennCare

(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

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Managed Care and Public Health

Summary

Table of Contents

Supplemental Materials