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Anbieterorientierte Managed-Care-Organisationen und -Produkte

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Managed Care

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Zusammenfassung

Managed Care ermöglichte die Durchsetzung einer Vielzahl von Organisationsformen, die von den Anbietern von Gesundheitsdienstleistungen eingeführt wurden. Einerseits gibt es die traditionellen Modelle wie die Independent Practice Associations (IPAs), welche die Interessen der Ärzte in Verkaufsgenossenschaften vertreten. Diese existieren neben anderen konventionellen Netzwerkstrukturen. Darüber hinaus haben sich zwei neue Organisationsformen entwickelt. Accountable Care Organisations (ACOs) übernehmen die Gesundheitsversorgung für eine bestimmte Bevölkerungsgruppe, während sich Patient Centered Medical Homes (PCMHs) auf die Versorgung auf der Ebene der Hausärzte konzentrieren. Dieses Kapitel ist der Erörterung dieser Organisationen und Produkte gewidmet.

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Notes

  1. 1.

    Shortell bevorzugt diesen Begriff, um den Begriff integrierte Versorgungssysteme für Organisationsformen frei zu lassen, die heute noch nicht auf dem Markt zu finden sind. Diese würden – darin sehen Shortell et al. die besondere Leistungsstärke – auch in unmittelbarer Kooperation mit öffentlichen Sozialverwaltungen, im Sinne eines health managements, interagieren (Shortell et al., 1996, S. 8).

  2. 2.

    So hat Montefiore, eines der bedeutendsten Versorgungssysteme in New York, in den letzten 10 Jahren 200 Mio. $ in den Auf- und Ausbau der Informationstechnologie investiert.

  3. 3.

    Diese These ist nicht unumstritten, und es finden sich ausreichend Beispiele, die das Gegenteil belegen. Siehe hierzu auch das Kapitel zum Gatekeeping.

  4. 4.

    Auch diese These, die zum Beispiel von Lega (2007, S. 259) vertreten wird, ist nicht unumstritten. Einige Vertreter sehen die fachärztliche Behandlung als die kostengünstigere Variante an, da unnötige Fehldiagnosen vermieden werden.

  5. 5.

    The Commonwealth Fund´s Commission on a High Performance Health System.

  6. 6.

    The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians und the American Osteopathic Association.

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  1. Institut für Sozialmedizin, Epidemiologie und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Deutschland

    Volker Eric Amelung

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Amelung, V.E. (2022). Anbieterorientierte Managed-Care-Organisationen und -Produkte. In: Managed Care. Springer Gabler, Wiesbaden. https://doi.org/10.1007/978-3-658-12527-1_6

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