Medicaid: Factors to Consider in Expanding Managed Care Programs.

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

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Document Details

Document Type
Technical Report
Publication Date
Apr 10, 1992
Accession Number
ADA290122

Entities

Organizations

  • United States Government Accountability Office

Tags

DTIC Thesaurus Topics

  • Business Administration
  • Contracts
  • Delivery Of Health Care
  • District Of Columbia
  • Governments
  • Health Care
  • Health Maintenance Organizations
  • Health Services
  • Hospitals
  • Human Resources
  • Lessons Learned
  • Medical Personnel
  • Money
  • Motivation
  • Personnel Management
  • Physicians
  • United States

Fields of Study

  • Medicine

Readers

  • Defense Financial Management and Audit.
  • Government Contracting/Procurement.
  • Medical or Health Care Field.