ABSTRACT
In an ideal world, managed care should mean “managing processes of care” rather than managing care providers. Management of a process of care implies that the operators have information that will enable them to reasonably predict the outcome (or output) of the process. Information for management of processes is a goal of physicians and nurses that may be achieved through systematic feedback, scientific evidence, aggregate data from populations, and statistical analysis. The prepayment of health care services through a capitated financing mechanism is a dominant scheme in the managed care environment. A crude reduction of this method, and its effect on the bottom line of the health care organization’s balance sheet, involves the pursuit of one of two objectives: deny or defer access to health care services or prevent the need for health care (especially “sickcare”) services.
