Chinese Journal of Hospital Administration 2010;26(11):871-876

doi:10.3760/cma.j.issn.1000-6672.2010.11.028

Reference of and comparison between managed care and traditional medical insurance in America

Liuzhen XIAO

Keywords

United States; Managed care; Traditional health insurance

Country

China

Language

Chinese

Abstract

Managed care insurance is growing into the mainstream health insurance model in the United States. The differences between this and the traditional health insurance lie in their economic model, their autonomy of consumers in their choices of suppliers, their economic risk exposure for clinicians, their effect on utilization review and their impact to clinical decision-making. Managed care can only, in terms of cost constraints, affect or limit the autonomy of medical decision, instead of making decisions in lieu of clinicians. Under managed care, both the professional risk of clinicians and health benefits of consumers are exposed to obvious negative influence. In the meantime, the model is facing growing difficulties in the future for the market itself. In this regard, prudence is required to introduce managed care in China.