Accession Number : ADA290122

Title :   Medicaid: Factors to Consider in Expanding Managed Care Programs.

Corporate Author : GENERAL ACCOUNTING OFFICE WASHINGTON DC HUMAN RESOURCES DIV

PDF Url : ADA290122

Report Date : 10 APR 1992

Pagination or Media Count : 12

Abstract : In conclusion, managed care programs can offer an opportunity to improve access to quality health care. Because of the financial incentives of such programs and the vulnerability of the Medicaid population, we believe a set of safeguards must be instituted to assure adequate protection for recipients. These include a quality assurance system that requires client satisfaction and disenrollment surveys; a grievance procedure; and an outside independent review of medical records. Further, to reduce financial risks, states need to monitor: the financial arrangements between the contracting plan and its individual providers for excessive incentives not to provide necessary services; utilization services are being provided; subcontracts in the same manner as contracts because the same problems can arise. Finally, effective state and federal oversight is needed along with prompt corrective actions when problems are identified. JMD

Descriptors :   *BUDGETS, *MEDICAL SERVICES, *HEALTH CARE FACILITIES, CONTRACTS, VULNERABILITY, MEDICINE, QUALITY, SAFETY, QUALITY ASSURANCE, RECORDS, UTILIZATION.

Subject Categories : Medicine and Medical Research
      Economics and Cost Analysis

Distribution Statement : APPROVED FOR PUBLIC RELEASE