MANAGED CARE IN THE UNITED-STATES

Medical care in the United States continues to consume an increasing a mount of the Gross Domestic Product. To control the rising costs of he alth care many industries have turned to a controlled form of financin g and delivery of health care often referred to as managed care. Many types of managed care exist, including preferred provider organization s (PPO), exclusive provider organization (EPO), and health maintenance organizations (HMO). HMOs involve prepaid premiums, limited panels of providers and assumption of financial risk on the part of the provide rs. A variety of HMOs are currently operating in the United States. Ma naged care involves taking risks by those who administer it. Some meth ods of controlling patient and physician behaviour by taking risks are capitation, risk pools and withholds. With capitation the physician i s paid a 'per member per month' fee regardless of whether the patient uses the service. Risk pools are concerned with who shares the risk; f or example, the primary physician shares the financial risk with speci alists. Withholds involve a fee-for-service with a portion withheld wh ich may be returned to the provider if he/she is parsimonious. A conce rn expressed about HMOs is the possibility of restricted services. Mor eover, hospital expenses make up a large portion of the total health c are dollar. In 1995 the average length of stay for a Medicare patient was 6.1 days as opposed to 3.9 days for the non-Medicare patient. Inde ed, HMOs were the leaders in the development of same-day surgery and o ut-patient treatment. Increasingly, in the United States, public and s ocial insurance plans are turning to managed care as a method expendit ure. Some government as Medicare and Medicaid, also increasingly offer managed health options. The trend, for now, in the United States incr eases enrollment in managed care plans. Although this is occurring at a rapid pace, managed care will probably not be the final solution to provision of medical care in the United States.