MANAGED CARE TRENDS & ISSUES

Managed Care Trends & Issues

Managed Care Trends & Issues

Introduction

Managed Care is a systematic process that helps healthcare providers identify, evaluate, and address problems that might injure patients, lead to malpractice claims, and cause financial loss to healthcare entities. However, it is not merely a system of defensive medicine but one that aspires - ultimately - to improve the safety and quality of health care. Successful Managed Care programs meet four basic requirements: attitude, knowledge, skill, and commitment. It seeks to identify areas of real or potential risk. It calculates the probability of an adverse effect from a risk situation. It estimates the impact of the adverse effect.

Analysis

In UK, from the late 1970s to the early 1990s, community health services used collaborative strategies to change the way services were delivered. By the end of this period, the networks of personal and organisational relationships had been well documented (Walker, 1992, pp. 257-264). These networks never disappeared, and provided a foundation for contemporary partnership strategies in primary health care. The market reforms of the 1990s created tensions between cooperation and competition in the primary health care sector (Lewis & Walker, 1997, pp 45-389).

Key clinical risk areas

Areas within the practice of pediatrics that have been identified as high risk include newborn care, adolescent care, emergency pediatrics, vaccine administration, medication errors, and care provided by telephone. Newborn care issues include both prenatal and perinatal diagnosis and treatment, normal newborn care, and care provided to critically ill newborns.

Prenatal and perinatal care issues encompass subjects such as attendance (or lack of attendance) at high-risk deliveries; complications that arise during labour and delivery (such as intrapartum asphyxia, improper or delayed resuscitation, and management of intrapartum infection); and inadequate communication (between the obstetrician and pediatrician/neonatologist, the nurse and physician, or the healthcare team and the family).

Whereas care of the 'normal' newborn is generally not considered to be a high-risk area, vulnerability exists nonetheless. Complications occurring during procedures (including lack of appropriate informed consent), failure to act on abnormal screening tests, management of neonatal jaundice, problems related to early neonatal discharge, and undiagnosed developmental dysplasia of the hip are frequently cited allegations(Das & Teng, 2001, p. 258).

Not surprisingly, management of the critically ill newborn is fraught with medicolegal hazards. Allegations might arise from the care delivered during any phase of the transport/referral/assessment process, care delivered in the neonatal intensive care unit, and complications sustained during procedures or treatment, or it might be outcomes based, such as in the case of neurological impairment.

Medication errors

Medication errors continue to be a significant source of both medical injury and medical malpractice allegations. In a 7-year study of filed medical liability lawsuits encompassing more than 90,000 claims, medication error was the second most prominent cause and the second most expensive basis for litigation. Pediatrics ranked sixth among 16 medical specialties in medication-related claims. Pediatric settlements were about twice those of other specialties, averaging nearly $300,000 in indemnity per case(Sztompka, 1999, pp ...