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What Is the Health Consumer's Role in the Health Care Crisis?

There have been a rash of bankruptcies among large medical groups taking on full-risk contracts in California, and it's raising the question of how much risk medical groups can reasonably take on. Some argue that the bankruptcies are simply a market shakeout, with poorly managed groups going under as a natural consequence of the business cycle. Others see it as a harbinger of the collapse of global capitation. A panel of experts--practicing doctors, insurance actuaries, and medical directors--debate the future of physicians taking on financial risk in this feature from "Between Rounds," a "webzine" for physicians.
Redirecting Risk

This article from "Between Rounds" (a "webzine for physicians") explores alternatives to traditional capitation--"reverse capitation," in which primary care physicians are paid on a fee-for-service basis, while specialists are capitated; "contact capitation," which rewards specialists who take more referrals; and payment of a fixed fee for all services required for various "episodes of care," for example, the course of a pregnancy. Each of these models is an attempt to counteract the incentives for undertreatment inherent in the traditional capitation model. The article concludes, however, that these systems, too, have their flaws.
The High Price of Health

FRONTLINE's 1998 report on the managed care revolution provides a wealth of background readings and interviews on the emergence and triumph of managed care in the 1980s and 90s.
Capitation: A Collection of Articles from Managed Care Magazine

Although "Managed Care" magazine is targeted toward doctors, the articles collected here--including "The March of Capitation: Reversed or Just Delayed?" and "The Future of Capitation In a World of Shared Risk"-- are accessible and provide further background for the layman interested in understanding capitated payment systems and their place in managed care today.

Center for Patient Advocacy

The Center for Patient Advocacy is a non-profit organization that lobbies for consumer-oriented health care reform and offers assistance to consumers trying to navigate the maze of managed care. Their web site provides resources for "checking out your doctor": questions to ask him or her about training and background, and state-by-state contact information for boards of medicine; fact sheets and articles on health insurance and managed care; and updates on managed care and other health care reform legislation. The Center also has a toll-free hotline (800-846-7444) for advice and assistance with managed care issues.
Managed Care Central

"Managed Care Central" is a project of Families USA, a national nonprofit organization "dedicated to the achievement of high-quality, affordable health and long-term care for all Americans." Their web site includes an extensive section called "What Consumers Needs to Know" which provides tips on choosing an HMO and links to a variety of resources through which consumers can rate their health plans. The site also includes contact information for submitting complaints about your managed care plan, updates on "patient bill of rights"legistation under consideration and extensive state-by-state information on legislation and services.
National Committee for Quality Assurance

The NCQA has run a voluntary accreditation system for managed care organizations since 1991. Their web site offers an interactive "health plan report card," which allows consumers to access the ratings and accreditation status of individual health plans with respect to access and service, qualified providers, staying healthy, getting better, and living with illness. The NCQA also oversees the development of HEDIS (Health Plan Employer Data and Information Set) a set of standardized measures used to compare health plans, complementary to but different from accreditation. HEDIS evaluates the results a health plan actually achieves in dozens of key areas of care and service such as immunization rates, cholesterol management, and member satisfaction.
Making the Health Care System Work for You: A Guide for Patients

This is a resource provided by the Massachusetts Hospital Association and The Picker Institute. It answers frequently asked questions; recommends further questions for you to ask your doctors, nurses, and hospital staff; and offers strategies to help you get the most out of your hospital care.
Joint Commission on Accreditation of health care Organizations

The JCAHO evaluates and accredits more than 18,000 health care organizations and programs in the United States. Click on 'General Public' to find advice on choosing health plans as well as other health services such as ambulatory care, home care, hospitals, long-term care, substance abuse help, mental health services, and child/adolescent services. There's also a place on this site for registering complaints against accredited health care providers.
Care Counsel, LLC<

Care Counsel is a privately held company based in San Rafael, California, founded in 1996 to provide expert help for consumers as they navigate the new health care environment. They offer a "health care Assistance Program" for employers to help employees understand and navigate managed care systems. In addition, their web site provides a number of helpful essays and fact sheets for consumers, including "Navigating Managed Care with Patient Advocacy," "Choosing a Primary Care Physician," "How to Get Your Medical Records," "Keeping a Personal Health Record, Second Opinions," "Talking with Your Doctor," and "Selecting a Health Plan."
FACCT - The Foundation for Accountability

FACCT is a non-profit organization devoted to providing comprehensive comparative information about health plans and providers to consumers to enable them to make more educated decisions when choosing a plan or course of treatment. This extensive research project is still under development. Currently the site provides a number of measurement guides designed for doctors and other providers. According to FACCT President David Lansky, their exclusive consumer-oriented content providing ratings for doctors and health plans will be available on line beginning August, 2000.

·  CareGroup health care System
·  Joslin Diabetes Center
·  Beth Israel Deaconess Medical Center
·  The Official U.S. Government Site for Medicare Information
·  American Association of Medical Colleges

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