Summary of Lectures (Part 2)

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University of Toronto Scarborough
Economics for Management Studies
Michele Campolieti

ECMC34 March 16 Workers compensation insurance costs are rising, but not in the normal health care - Costs are higher because someone is paying for it - Constraints on physicians on what treatment they can provide Managed Care - A system in which physician practice is managed in order to address high health care costs - Managed Care Organization (MCO) - Health Management Organization (HMO) - Fee for Service (FFS) - Preferred provider organization (PPO) - Point of service (POS) Managed care reduces overconsumption of health care by imposing cost control incentives (on both physician + patient) - Set up a network, collection of physicians, hospitals clinics, home care to a defined population in an area - Network is clinically (quality) + fiscally (cost) responsible to treat the defined population - Fixed budget to a certain network, less profits Contain costs + quality of care through a few mechanisms: - Selective contracting payers negotiate prices + select local physicians + hospitals - Steering send enrolees to selected providers - Utilization reviews 3 types 1) Prospective (before care) mandatory second opinions
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