What can Europe learn from the managed care backlash in the United States?

Duijmelinck, Daniëlle M.I.D.; Ven, Wynand van de

doi:10.1016/j.healthpol.2016.03.010

Cited by 14 publications

(14 citation statements)

References 53 publications

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“…Contracts are negotiated with the providers’ federal or state associations ensuring ‘sufficient, appropriate and economical’ services pursuant to the German social legislation [2]. Selective contracting, considered one of the most successful tools of the managed care techniques in the US, is not as effective for German insurers since collective contracts are still mandatory [3]. Regardless of the differences in health care systems and the diverse remuneration concepts, it is important for insurers, whether private or statutory, to know about the quality of the services they pay for.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist-led medication reviews for geriatric residents in German long-term care facilities

Bitter

Pehe²,

Krüger

et al. 2019

BMC Geriatr

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BackgroundThe benefit of medication reviews for long-term care (LTC) residents has been generally recognized throughout health care systems. Whereas many studies showed the impact of comprehensive medication reviews performed by specialized clinical pharmacists, little is known about the impact of medication reviews performed by community pharmacists. Involving them in the provision of medication reviews may help satisfy the increasing demand for ensuring medication safety.MethodsCommunity pharmacists supplying drugs to the LTC facilities performed a medication review for German LTC residents aged at least 65 years and taking five or more drugs per day based on the patients’ medication only. Documented potential drug-related problems (DRPs) and the implementation rate of pharmaceutical interventions were evaluated descriptively. To assess the quality of the medication reviews, we developed a corresponding reference system based on the analysis of two experienced clinical pharmacists.ResultsTwelve pharmacies performed medication reviews for 94 LTC residents. Overall, the pharmacists documented 154 potential DRPs (mean 1.6 per patient, SD 1.5) of which the most common were drug-drug interactions (40%) followed by potentially inappropriate medication (PIM) (16%) and inappropriate dosages (14%). 33% of the pharmacists’ interventions to solve DRPs were successfully implemented, mostly dosage adjustments. The identification of potentially severe drug-drug interactions and PIM showed the highest agreement (88 and 73%) with the reference system.ConclusionsThe medication review program of community pharmacists for LTC residents led to the identification of relevant DRPs. The reference system assessing the quality of the service can contribute to its transparency and reveals the potential for its improvement. The community pharmacists’ knowledge of the LTC residents and their relation to the prescribers is crucial for providing successful medication reviews.

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Section: Introductionmentioning

confidence: 99%

Pharmacist-led medication reviews for geriatric residents in German long-term care facilities

Bitter

Pehe²,

Krüger

et al. 2019

BMC Geriatr

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“…Doctors in the United States have as yet been unable to motivate the government under any presidential administration to adopt universal basic health care or even to get the U.S. public to endorse it, despite the fact that this health care would be in the interests of all Americans 16 . They were unable to resist the rise of managed care in the 1990s or the destructive impacts of the introduction of electronic medical records in the 2000s 17 . Topol himself notes that “it was, after all, doctors themselves who allowed the invasion of grossly inadequate electronic health records into the clinic, never standing up to companies like Epic, which has, in its contracts with hospitals and doctors, a gag clause that prohibits them from disparaging electronic health records or even publishing EHR screenshots.” 18…”

Section: Essaymentioning

confidence: 99%

“…16 They were unable to resist the rise of managed care in the 1990s or the destructive impacts of the introduction of electronic medical records in the 2000s. 17 Topol himself notes that "it was, after all, doctors themselves who allowed the invasion of grossly inadequate electronic health records into the clinic, never standing up to companies like Epic, which has, in its contracts with hospitals and doctors, a gag clause that prohibits them from disparaging electronic health records or even publishing EHR screenshots." 18 This history of failure provides little grounds for confidence that the medical profession will be able to resist the same economic, political, and institutional dynamics when it comes to the adoption of AI.…”

Section: Essaysmentioning

confidence: 99%

High Hopes for “Deep Medicine”? AI, Economics, and the Future of Care

Sparrow¹,

Hatherley²

2020

Hastings Center Report

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In the much‐celebrated book Deep Medicine, Eric Topol argues that the development of artificial intelligence for health care will lead to a dramatic shift in the culture and practice of medicine. In the next several decades, he suggests, AI will become sophisticated enough that many of the everyday tasks of physicians could be delegated to it. Topol is perhaps the most articulate advocate of the benefits of AI in medicine, but he is hardly alone in spruiking its potential to allow physicians to dedicate more of their time and attention to providing empathetic care for their patients in the future. Unfortunately, several factors suggest a radically different picture for the future of health care. Far from facilitating a return to a time of closer doctor‐patient relationships, the use of medical AI seems likely to further erode therapeutic relationships and threaten professional and patient satisfaction.

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“…Another instrument is appointing preferred providers. This means that patients retain their freedom to choose a provider, but insurers stimulate enrollees to opt for providers with whom they have made agreements on price, quality and/or volume of care [6, 8–10]. We focus on this instrument in the current study.…”

Section: Introductionmentioning

confidence: 99%

An assessment of the Dutch experience with health insurers acting as healthcare advisors

et al. 2019

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IntroductionWith managed competition, selective contracting and the appointing of preferred providers are important instruments for health insurers to improve their bargaining position in the healthcare purchasing market. Insurers can offer enrollees extra services, such as advice about their healthcare, to attract them, ensure that they remain loyal, and to channel them to preferred providers. We investigate which advice services insurers in the Dutch system of managed competition offer enrollees, how they inform them about services, and if enrollees use and appreciate them.Materials and methodsFrom November to December 2017, two researchers independently analyzed the websites of all health insurers in the Netherlands. We also conducted a questionnaire study among 1,500 members (response 44.5%, N = 668) of the Nivel Dutch Health Care Consumer Panel.Results and discussionAll insurers offer one or more services. Most enrollees do not know if their insurer offers advice (67–87% per service). Twelve per cent (N = 76) of the enrollees indicate that they ever made use of a service, mostly regarding the choice of provider (N = 42). Respondents who used healthcare advice were satisfied with it. Of all enrollees, 41% indicate that they would probably/certainly, contact their insurer for advice and 37% would appreciate it if their insurer approached them. Among enrollees, 40% indicated the potential advice has some or a major influence on their choice of insurer.ConclusionsWhile all insurers offer at least one service, enrollees generally are unaware of them. Only a minority ever made use of such a service. However, a reasonable proportion do appreciate their insurers’ advice services and indicate that they would like to have contact with their insurer if they need care. Insurers do not appear to make the best use of the potential for giving healthcare advice and need to think about ways to increase coverage of those services.

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What can Europe learn from the managed care backlash in the United States?

Cited by 14 publications

References 53 publications

Pharmacist-led medication reviews for geriatric residents in German long-term care facilities

Pharmacist-led medication reviews for geriatric residents in German long-term care facilities

High Hopes for “Deep Medicine”? AI, Economics, and the Future of Care

An assessment of the Dutch experience with health insurers acting as healthcare advisors

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