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A
History of Managed Care
In 1910, the Western Clinic in Tacoma, Washington offered
a broad range of medical services exclusively through its providers
for a premium payment of $.50 per month. It served lumber mill owners
and employees.
In 1929,
Baylor Hospital (Texas) agreed to provide on a prepaid basis, coverage
by the case at its hospital for some 1,500 teachers; this arrangement
represented the origins of Blue Cross.
In 1937,
the Kaiser Foundation Health Plans were started and they were intended
to finance the medical care of the Kaiser Construction Company's workers
and their families.
To reduce
the number of mortgage defaults that results from large medical expenses,
the Group Health Association (GHA) was started in Washington, DC;
this was a nonprofit consumer cooperative, created on behalf of the Home
Owner's Loan Corporation.
In 1944,
the Health Insurance Plan (HIP) of Greater NY was formed to provide
healthcare coverage for City of New York employees.
In 1947,
the Group Health Cooperative of Puget Sound was formalized, having been
organized by 400 families who contributed $100 each.
The HMO
Act of 1973
· Grants & loans available for planning and start-up phases of new HMOs
as well as for service area expansions
· State laws restricting development of HMO's were overridden for HMO's
that were federally qualified
· Established process for HMOs to be federally qualified
· Dual choice provisions requiring employers with over 25 employees who
offer in-dementia coverage to also offer two federally qualified HMOs,
one closed panel and one panel.
The Tax
Equity and Fiscal Responsibility Act of 1982
· Codified Medicare risk contracts 1985 Omnibus Budget Reconciliation
Act
· Reemphasized 50/50 rule -- to be approved as a health plan, one needs
to see a 50/50 split: Commerical and Medicaid lives (waivers for "good"
Plans, abounded)
· Requires member rights notification
· Expanded peer review (PRO)
· Mandated study of physician incentive arrangements
1997 Balanced
Budget Act of 1997
· Permits contracts with PSO and PPO plans, Private FFS and MSAs
· New eligibility regulations
· Emphasizes on contractual language issues Managed Care
Another
perspective of the History of Managed Care:
1929 Ross-Loos clinic of Los Angeles; Water & Power Authority; then others
1929 hospital insurance-Blue Cross in Tx
1930-Sidney Garfield-Kaiser Permanente For Workers, Aqueduct of the Colorado
River (emptying in L.A.
1929 Dr. Shadid' prepaid contract Rural Farmers Cooperative in Elk City,
OK
from Kassirer, Ginzberg, Ostow. "Is Managed Care Here To Stay?"
New Eng J Med 4/3/97 HMO Act of 1973: pursuant to P.L.93-222 per
Paul Elwood's "Health Maintenance Strategy" leading to Federally Qualified
HMOs
Source:
"Primary Care Strategy" Managed Care, History of www.mcol.com
A comprehensive
presentation used by the American College of Managed Care Medicine
(with permission, 3.14.02 Dr. W. C. Williams via Dr. Balvindar S. Sareen)
See also,
"The Emerging Managed Care Paradigm: Health Care in Transition." Medical
Interface. Vol 7(9); Sept., 1994:58-59.
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