Kennedy Institute of Ethics Journal 7 (4):331-336 (1997)
: The answer to the question of what health care services should be covered by a managed care plan is straightforward; the plan should cover whatever the consumer is willing to pay for. From the plan's perspective, the consumer is the payer, that is, the employer who negotiates the plan; not the individual patient whose personal preferences and interests may be quite different. Since managed care organizations contract with payers to arrange for health care services within a defined set of benefits, there is a broader question as well: Within the benefits chosen by the payer, what actually is covered? Criteria for determining "medical necessity," which managed care plans frequently use as the basis for coverage, are discussed
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
References found in this work BETA
No references found.
Citations of this work BETA
The Concept of Underinsurance: A General Typology.Andrew Ward - 2006 - Journal of Medicine and Philosophy 31 (5):499 – 531.
Similar books and articles
Responsibility and Health Care, Who Cares.... : An Introduction to the Principle of Genuine Responsibility and How This Principle Applies to the Managed Care Model of Health Care Distribution. Verheijde, Josephus Leonardus - unknown
Paying for Medical Care: A Jewish View.Elliot N. Dorff - 1997 - Kennedy Institute of Ethics Journal 7 (1):15-30.
Talk Medicine: The Ultimate Survival Strategy.Harvey Lawrence Kugel - 1998 - Mantra Press International.
Health Care Reform and Abortion: A Catholic Moral Perspective.James T. McHugh - 1994 - Journal of Medicine and Philosophy 19 (5):491-500.
The Importance of Management for Understanding Managed Care.George G. J. Agich - 1999 - Journal of Medicine and Philosophy 24 (5):518 – 534.
The Metamorphosis of Managed Care: Implications for Health Reform Internationally.Marc A. Rodwin - 2010 - Journal of Law, Medicine & Ethics 38 (2):352-364.
Oregon Health Plan: Ration or Reason.Paige R. Sipes-Metzler - 1994 - Journal of Medicine and Philosophy 19 (4):305-314.
The United States Health Care System Under Managed Care: How the Commodification of Health Care Distorts Ethics and Threatens Equity. [REVIEW]Larry R. Churchill - 1999 - Health Care Analysis 7 (4):393-411.
Managed Care: How Economic Incentive Reforms Went Wrong.Madison Powers - 1997 - Kennedy Institute of Ethics Journal 7 (4):353-360.
Added to index2009-01-28
Total downloads8 ( #488,880 of 2,163,655 )
Recent downloads (6 months)1 ( #348,043 of 2,163,655 )
How can I increase my downloads?