Dissertations / Theses: 'Managed health care model'

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McCabe, Helen, and res cand@acu edu au. "The Ethical Implications of Incorporating Managed Care into the Australian Health Care Context." Australian Catholic University. School of Philosophy, 2004. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp48.29082005.

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AIMS Managed care is a market model of health care distribution, aspects of which are being incorporated into the Australian health care environment. Justifications for adopting managed care lie in purported claims to higher levels of efficiency and greater ‘consumer’ choice. The purpose of this research, then, is to determine the ethical implications of adapting this particular administrative model to Australia’s health care system. In general, it is intended to provide ethical guidance for health care administrators and policy-makers, health care practitioners, patients and the wider community. SCOPE Managed care emerges as a product of the contemporary, neo-liberal market with which it is inextricably linked. In order to understand the nature of this concept, then, this research necessarily includes a limited account of the nature of the market in which managed care is situated and disseminated. While a more detailed examination of the neo-liberal market is worthy of a thesis in itself, this project attends, less ambitiously, to two general concerns. Firstly, against a background of various histories of health care distribution, it assesses the market’s propensity for upholding the moral requirements of health care distributive decision-making. This aspect of the analysis is informed by a framework for health care morality the construction of which accompanies an inquiry into the moral nature of health care, including a deliberation about rights-claims to health care and the proper means of its distribution. Secondly, by way of offering a precautionary tale, it examines the organisational structures and regulations by which its expansionary ambitions are promoted and realised. CONCLUSIONS As a market solution to the problem of administering health care resources, the pursuit of cost-control, if not actual profit, becomes the primary objective of health care activity under managed care. Hence, the moral purposes of health care provision, as pursued within the therapeutic relationship and expressed through the social provision of health care, are displaced by the economic purposes of the ‘free’ market. Accordingly, the integrity of both health care practitioners and communities is corrupted. At the same time, it is demonstrated that the claims of managed care proponents to higher levels of efficiency are largely unfounded; indeed, under managed care, health care costs have continued to rise. At the same time, levels of access to health care have deteriorated. These adverse outcomes of managed care are borne, most particularly, by poorer members of communities. Further, contrary to the claims of its proponents, choice as to the availability and kinds of health care services is diminished. Moreover, the competitive market in which managed care is situated has given rise to a plethora of bankruptcies, mergers and alliances in the United States where the market is now characterised by oligopoly and monopoly providers. In this way, a viable market in health care is largely disproved. Nonetheless, when protected within a non-market context and subject to the requirements of justice, a limited number of managed care techniques can assist Australia’s efforts to conserve the resources of health care. However, any more robust adoption of this concept would be ethically indefensible.

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Waterstraat, Frank Riegle Rodney P. "Adapting the quality function deployment model to health plan design." Normal, Ill. Illinois State University, 2001. http://wwwlib.umi.com/cr/ilstu/fullcit?p3064505.

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Thesis (Ph. D.)--Illinois State University, 2001.
Title from title page screen, viewed March 10, 2006. Dissertation Committee: Rodney P. Riegle (chair), J. Christopher Eisele, George Padavil, John H. Bantham, Thomas J. Bierma. Includes bibliographical references (leaves 124-128) and abstract. Also available in print.

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Nearon, Darrell Maxwell Jr. "A study of the relationship between health care access and access barriers to behavioral health care for African Americans utilizing the managed care model." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2001. http://digitalcommons.auctr.edu/dissertations/AAI3034591.

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Managed care has revolutionized the healthcare industry. Prior to managed care, traditional insurance companies managed the healthcare industry. These insurance firms would monitor and authorize treatment to persons enrolled with the insurance company. Health Maintenance Organizations (HMOs) began to develop methods to provide similar service as the large insurance companies at a fraction of the cost. HMOs accomplished this by selling their products directly to employer groups. This significantly reduced administrative costs that had been traditionally passed on to the consumer. Unable to financially keep pace with the HMOs, the insurance companies abandoned the health insurance arena. As managed care has grown so have the problems associated with his system. Issues involving antitrust, confidentiality, privacy, and best practices are but a few of the critical issues facing managed care. All three branches of the United States government have been involved in resolving issues pertaining to managed care. Reforms have been demanded from the system and the current political climate may force the system to reconsider the manner in which it is conducting business. Minority consumers and specifically African Americans traditionally have been discriminated against from engaging in such life activities as housing, voting, commerce, and banking, without judicial intervention. The healthcare industry is no exception. The United States Surgeon General, in his seminal report on mental health, identifies that African Americans and other minorities have been excluded from obtaining appropriate and timely healthcare. The Surgeon General's report coupled with the President's report on Healthy People 2000, identify that initiatives are needed to rectify the inequities in healthcare in healthcare service delivery. A total of fifty-two African American consumers of mental health service with a primary diagnosis of adjustment disorder were surveyed to assess their perceptions as to whether or not they have access to their behavioral health services. The Consumer Access Questionnaire was designed to gather both demographic and consumer perceptions on the accessibility and feasibility of managed care for this selected population of African Americans. In all categories surveyed on the questionnaire, the results revealed that the respondents were able to access their outpatient behavioral health provider when utilizing the managed care system. The respondents provided an overall satisfaction rate with their respective managed care plans.

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Nearon, Darrell M. "A study of the relationship between health care access and access barriers to behavioral health care for African Americans utilizing the managed care model." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2001. http://digitalcommons.auctr.edu/dissertations/3784.

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Managed care has revolutionized the healthcare industry. Prior to managed care, traditional insurance companies managed the healthcare industry. These insurance firms would monitor and authorize treatment to persons enrolled with the insurance company. Health Maintenance Organizations (HMOs) began to develop methods to provide similar service as the large insurance companies at a fraction of the cost. HMOs accomplished this by selling their products directly to employer groups. This significantly reduced administrative costs that had been traditionally passed on to the consumer. Unable to financially keep pace with the HMOs, the insurance companies abandoned the health insurance arena. As managed care has grown so have the problems associated with his system. Issues involving antitrust, confidentiality, privacy, and best practices are but a few of the critical issues facing managed care. All three branches of the United States government have been involved in resolving issues pertaining to managed care. Reforms have been demanded from the system and the current political climate may force the system to reconsider the manner in which it is conducting business. Minority consumers and specifically African Americans traditionally have been discriminated against from engaging in such life activities as housing, voting, commerce, and banking, without judicial intervention. The healthcare industry is no exception. The United States Surgeon General, in his seminal report on mental health, identifies that African Americans and other minorities have been excluded from obtaining appropriate and timely healthcare. The Surgeon General’s report coupled with the President’s report on Healthy People 2000, identify that initiatives are needed to rectify the inequities in healthcare in healthcare service delivery. A total of fifty-two African American consumers of mental health service with a primary diagnosis of adjustment disorder were surveyed to assess their perceptions as to whether or not they have access to their behavioral health services. The Consumer Access Questionnaire was designed to gather both demographic and consumer perceptions on the accessibility and feasibility of managed care for this selected population of African Americans. In all categories surveyed on the questionnaire, the results revealed that the respondents were able to access their outpatient behavioral health provider when utilizing the managed care system. The respondents provided an overall satisfaction rate with their respective managed care plans. 2

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Carney, Philip Sheridan. "Managed healthcare and integrated delivery systems: A model for getting ahead of the change curve." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2103.

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Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.

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Flood, Colleen M. "Comparing models of health care reform, internal markets and managed competition." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0003/NQ33923.pdf.

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Dune, Douglas T. "An Expandable Markov Model for the Design of Intelligent Communicative Agents in managed Health Care." NSUWorks, 2000. http://nsuworks.nova.edu/gscis_etd/497.

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In the field of medicine, decisions are often difficult to make in the absence of clear symptoms, decisive test results and adequate patient involvement. Medicine in most cases is still an art, using science for its basic foundation. Everyday practice relies on the case-study method, trial and error, and intuitive judgement. In some medical specialties there is heavy reliance on intangibles. For example, human motivation plays a significant role in complex medical decisions affected by many variables which remain unquantifiable and intangible; indeed most variables that determine outcome are hidden, including human motivation. The complexity of medical information systems demands that new ways be investigated that emphasize timeliness and efficiency. Medical information systems are no longer centralized; they are distributed over networks and the Internet. Interoperability has become a requirement in order for these heterogeneous systems be able to exchange information and work together in a cooperative manner. For this reason the design of decision processes within the general domains of medicine require further analyzation and establishing a methodology for developing a flexible agent architecture for the creation of intelligent agent systems in medicine. Thus, this research provided the underlying theoretical framework for the design of interactive intelligent agents in the medical domain examining the design of open and flexible architectures. In the last decade rapid development of agent technologies has occurred. Research of multi-agent systems sprung from earlier works in artificial intelligence and decision sciences. Complementing the study of agent technologies is the discipline of mathematical modeling. Adapted Markov models were applied to facilitate the methodology of the study emphasizing the process by which real decisions are formalized rather than the solution to already formalized problems. Another important element of this dissertation was the use of clinical pathways; fundamental guidelines that are components of managed health care. Clinical pathways were at the core of the architecture and formed the basis of a suitable expandable and adaptive Markov model. The results of the model are a derivation of intelligent agent architecture for the medical domain. The methodology exploited the generality, flexibility and normative power of Markov models, particularly, fully observable Markov decision processes (FOMDP) and partially observable Markov decision processes (POMDP). Based on both the FOMDP and POMDP, an expandable observable Markov decision process (EOMDP) model was formulated. The formulated model was further revised and reformulated based on the phenomenological observation and measure of clinical pathways. This approach is mathematically sound, computationally efficient, and intuitively appealing.

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Janus, Katharina. "Managing health care in private organizations : transaction costs, cooperation and modes of organization in the value chain /." Frankfurt am Main [u.a.] : Lang, 2003. http://www.gbv.de/dms/zbw/371113903.pdf.

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Du, Preez Karen Kay. "Towards a values-based model to manage joint academic appointments in the health sector in South Africa." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/28293.

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Joint appointments in the health sector in South Africa are made to serve both service and academic functions in one post. Typically the employing organisations are unequal, as one of them is the paying organisation while the other is the academic employer. This practice has been in existence for decades, and is ruled by expediency rather than being based on values. Joint employees experience role confusion, job confusion, dual loyalty confusion and being managed according to the rules of two organisations. This suboptimal situation leads to lower-than-expected performance in the eyes of both employing organisations. In this study the knowledge and problem areas of joint appointments were explored. The first part of the study consisted of a questionnaire analysis of the knowledge and view of problems as expressed by joint staff as well as by human resources (HR) practitioners. Group discussions, as well as the major part of the study, namely, interviews with senior management staff of both organisations were then conducted. In order to complete the study, an analysis was made of values that might inform on the problem. Joint staff members were found to have limited knowledge of the work requirements of a joint employee, and expressed concern about loyalty and role confusion. When the values were discussed with senior management staff, some values were identified as informing on possible solutions such as joint establishment of vision, joint objectives, respect for all components of the job, as well as generic values, including honesty, transparency, fairness, diversity and others. A framework is suggested commenting on the potential place for a values-based approach. From this a model is proposed by means of which a values-based process can be initiated by a top-level agreement meeting (“meeting of the minds”) of both employers that may lead to a single joint vision and set of objectives. From this agreement a policymaking joint body can establish the rules, while application and implementation are monitored by local joint management committees.
Dissertation (MCom)--University of Pretoria, 2011.
Human Resource Management
unrestricted

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Donato, Francis A. "Reforming health care through managed care." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1995. http://www.kutztown.edu/library/services/remote_access.asp.

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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.
Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).

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Čížová, Ludmila. "Problematika řízené péče (managed care)." Master's thesis, Vysoká škola ekonomická v Praze, 2008. http://www.nusl.cz/ntk/nusl-10176.

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The main theme of the thesis is managed care system description and definition. The first part is focused on managed care history, development in this system, and types of organizations providing this medical and hospital services. There is also chapter concerned with problems of resource management and managed care quality. The next chapter describes medical and health services and managed care in the USA, the only country offering these services in free mareket economy. For comparison in the next chapter there are presented someEuropean states, which try to introduce managed care as a tool for reduction of redundant and duplicate health services costs, include Czech Republic. At the conclusion, the comparison of some economic indicator of medical and health services among some European contries and the USA has been done.

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Abramson, Beth S. "How Managed Behavioral Health Care Impacts Psychotherapeutic Practices." Antioch University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1347310977.

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Huston, Annette L. "Carilion: A Corporate System of Managed Health Care." Diss., Virginia Tech, 2001. http://hdl.handle.net/10919/29798.

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In the late 20th century, the management of care came under the control of large health care conglomerates, like the Carilion Health System in Roanoke, Virginia. This study examines the evolution of Carilion from its beginning in 1988 to the present and analyzes Carilion as a complex system by using analytical tools drawn from a variety of STS scholars. Carilion's mission began with its hospitals. From 1954-1988, Carilion's predecessor, the Roanoke Hospital Association, developed a network for delivering care, training programs and management to small community hospitals throughout southwest Virginia. In 1988, the Roanoke Hospital Association was officially renamed the Carilion Health System. In its initial phase, 1988-1992, Carilion expanded its hospital network into as many communities as possible. The thesis of this work is that Carilion and communities came together to see if they could build a corporation to manage care and, at the same time, maintain local traditions of care. From 1992-1996, Carilion transformed itself from a hospital organization to a health care system and finally to a managed care system in order to compete with rival Columbia/HCA. This transformation required the creation of a physician management company and a health plans division. In 1995, Carilion's administrators began a reengineering program which redefined services and strategies for corporate growth. This included construction of a state-of-the-art facility situated between two competing Columbia/HCA hospitals in the New River Valley. In 1998-2000, Carilion engaged in a massive advertising blitz to garner additional market share from Columbia/HCA. Carilion's marketing strategies show that health care has changed dramatically under a business model, in spite of corporate America's assurances that it would not. This study gives voice to health care workers who describe exactly how their experiences have changed since corporations, such as Carilion, began managing their work. Drawing on interviews with Carilion physicians, hospital administrators, board members and medical staffs, the day-to-day activities taking place within hospitals and physician practices comes to life. The narrations describe how difficult it is for groups working within Carilion's facilities to carry out Carilion's growth strategies while at the same time maintaining communities' traditions of care. Since 1999, Carilion moved in three new directions: the creation of the Carilion Biomedical Institute incorporating biotechnology and biomedicine; the institution of a hospital partial-ownership program, which meant Carilion did not have to assume full ownership and expenses of some facilities; and the installation of an electronic medical records system in physician practices to manage patients' data, physicians' costs and physicians' productivity. These new directions illustrate how Carilion envisions a different paradigm of care delivery. While the study addresses how Carilion became a managed care organization, this work represents foremost an analysis of system building in America today. Like most corporate systems, Carilion exemplifies a mix of social, economic and technological components that have been assembled to form a corporate entity. This work explains how corporate systems come to manage traditions, values and resources within communities and for communities.
Ph. D.

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Bornman, Magda. "Digital media as communication tools for health promotion in managed health care." Pretoria : [s.n.], 2000. http://upetd.up.ac.za/thesis/available/etd-07132006-105048/.

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Magner, MaryBeth. "The Effects of Managed Care on the Quality of Dental Hygiene Care." TopSCHOLAR®, 1998. http://digitalcommons.wku.edu/theses/344.

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Managed care has become a prominent mechanism for insuring dental care. Empirical research suggests that managed dental plans provide lower quality care to patients. However, few studies have specifically addressed the effects of managed care on the quality of dental hygiene care. Thus, in this study the researcher examines whether dental hygienists deliver a lower level of treatment to managed care patients than to those who are not subject to managed care. Questionnaire data were gathered from 193 members of the American Dental Hygienists' Association residing in the Chicago area. The primary independent variable, managed care, was measured with an item that asked the respondents to indicate the percentage of patients they treat that are insured by a managed dental plan. The questionnaire also contained items that measured the frequency in which the respondents perform 23 tasks that are indicators of quality of dental hygiene care. Principal components factor analysis of these 23 items yielded the study's two dependent variables: periodontal procedures and appointment time. Regression analysis of the data revealed a significant negative relationship between managed care and appointment time. This relationship may be attributable to an economic incentive on the part of dentist-employers who control the amount of time scheduled for dental hygienists' patients. Dentist-employers may reduce the time available for managed care patients in order to allow longer appointments for more profitable fee-for-service patients. The study results did not support the notion that managed care affects the extent to which dental hygienists perform periodontal procedures. These mixed results suggest that future research should examine the relationships between managed care and other aspects of quality of dental hygiene care not addressed in the current study.

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Webb, Janet Marie. "Information about primary care physicians considered most useful by managed health care consumers." CSUSB ScholarWorks, 1997. https://scholarworks.lib.csusb.edu/etd-project/1370.

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Hasson, James M. "The ramifications of managed care in the behavioral health care setting in Berks County." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1997. http://www.kutztown.edu/library/services/remote_access.asp.

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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1997.
Source: Masters Abstracts International, Volume: 45-06, page: 2943. Abstract precedes thesis as 1 preliminary leaf. Typescript. Includes bibliographical references (leaves 66-67).

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Fleming, Elaine. "Provider Networks in Health Care Markets." Thesis, Boston College, 2003. http://hdl.handle.net/2345/1807.

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Thesis advisor: Peter Gottschalk
Thesis advisor: Thomas McGuire
Thesis advisor: Donald Cox
Does managed care send expectant mothers to hospitals they would choose even if their choice of hospital was not limited? I find that Medicaid managed care patients are redirected to hospitals that enrollees of more generous insurance payers with the same personal characteristics do not go to. However, Medicare managed care enrollees do not face an increased risk of having a cesarean delivery at the hospital they attend, which is interpreted as evidence that they are redirected to high quality hospitals
Thesis (PhD) — Boston College, 2003
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Economics

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Walker, Benjamin F. "The advent of managed care an examination of the impact on behavioral human service delivery /." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 2006. http://www.kutztown.edu/library/services/remote_access.asp.

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Thesis (M.P.A. )--Kutztown University of Pennsylvania, 2006.
Source: Masters Abstracts International, Volume: 45-06, page: 2963. Typescript. Abstract precedes thesis as 2 leaves. Includes bibliographical references (leaves 77-84).

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Moe, Christine. "Medicare Managed Care Penetration and Prevalence of Older Adult Disability." VCU Scholars Compass, 2008. http://scholarscompass.vcu.edu/etd/1663.

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OBJECTIVE: To investigate the relationship between Medicare Managed Care (MMC) penetration and percentage of disability in older adults (individuals age 65 and older). Considering disability as an indicator of one or more unsuccessfully managed chronic diseases, this study investigates the assumption that managed care improves coordination of care, as well as access to preventive care. If managed care’s mandate is being met, then it should be evidenced in decreased prevalence of older adult disability. METHOD: Taking an ecological approach, this study used data from the Agency for Healthcare Research and Quality (AHRQ, 2003) to compare the percentage of older adult disability in counties from 30 states and the District of Columbia with high and low MMC penetration. Covariates representing various aspects of community context were introduced into a final multivariate linear regression to examine whether MMC penetration was a significant predictor of countywide percent of older adult disability. RESULTS: While MMC penetration was a significant predictor of prevalence of older adult disability in a bivariate analysis (r=-0.197, p < .001), it lost its significance in the final multivariate model. CONCLUSION: While this study does not demonstrate a relationship between MMC penetration and prevalence of older adult disability, it is possible that MMC, once fully implemented under the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, could lead to reduced prevalence of disability.

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Solis, Beatriz Maria. "Medi-Cal managed care enrollees diverse experiences and perceptions about the health care system /." Diss., Restricted to subscribing institutions, 2007. http://proquest.umi.com/pqdweb?did=1464129111&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.

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Joshi, Ashish Vikas. "HEALTH CARE UTILIZATION AND COSTS IN OHIO MEDICAID: MANAGED CARE VERSUS FEE-FOR-SERVICE." University of Cincinnati / OhioLINK, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=ucin976036967.

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So'Brien, van Putten Juliette M. "Diabetes self-management (DSM) education within managed care organizations in Ohio /." The Ohio State University, 1998. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487949508369574.

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Riffe, Holly Ann. "The Changing Nature of Clinical Social Work: Managed Care and Job Satisfaction /." The Ohio State University, 1995. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487928649987234.

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Stein, Bradley D. "Drug and alcohol treatment services among privately insured individuals in managed behavioral health care." Santa Monica, CA : RAND, 2003. http://www.rand.org/publications/RGSD/RGSD170/RGSD170.pdf.

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Grimes, Bonnie. "Veterans with Chronic Back Pain Managed in Primary Care: Patient Aligned Care Team." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4726.

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Chronic pain affects approximately 100 million adults in the United States annually, and costs exceeding $635 billion. Pain is the most common complaint in primary care, and chronic pain accounts for up to 16% of emergency room visits. Additionally, chronic pain accounts for 25% of missed workdays annually. Veterans are particularly vulnerable to chronic pain and have an increased incidence of chronic non-cancer pain. Chronic pain for veterans cost the Veterans Administration (VA) about $385 billion each year. This project evaluated the Patient Aligned Care Team (PACT) model to manage chronic lower back pain (CLBP) at a VA primary care center. The framework that guided the project was the theory of planned change and the chronic care model. A retrospective electronic chart review of demographic and pain management data was collected from a convenience sample of veterans (20 women, 20 men) with a history of CLBP managed by the primary care center for at least 1 year prior to and one year after the PACT model was implemented. Overall, the paired-samples t-test to was not statistically significant for improvements in veteran reported pain scores over time. However, there was a significant interaction between time and gender that indicates changes over time significantly differed because of gender. In addition, descriptively the mean pain levels were initially higher for men as compared to women, and these levels increased sharply for females over time while the men decreased. This project contributes positively to social change for veterans as the findings indicate an important gender difference in patient reported pain scores over time. There needs to be additional investigation to understand the etiology of the gender difference in the pain outcomes for CLBP.

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Moore, Shana L. "Is There a Trade-off? Infant Health Outcomes and Managed Care Competition." UKnowledge, 2016. http://uknowledge.uky.edu/msppa_etds/16.

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This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to a policy change. Utilizing a difference-in-difference-in-difference (DDD) estimation, this study found initial evidence in a competitive MCO environment of Traditional Medicaid average birth charges substantially more than births under a Medicaid MCO, while outcomes also revealed the incidence of normal delivery increased almost identical to that of private insurance. However, after a short time, average birth charges for infants born under Medicaid MCO climb higher than other payer-types and infant health begins to decline. Outcomes of this study signal that Managed Care infants are actually less healthy and cost substantially more than anticipated but it is possible that these outcomes can be attributed to insurance selection.

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Inkelas, Moira. "Incentives in a specialty care carve-out." Santa Monica, CA : RAND Graduate School, 2001. http://catalog.hathitrust.org/api/volumes/oclc/47357973.html.

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Coetzee, Renier. "An analysis of the usage of antibiotics in the private health care sector : a managed health care approach / Renier Coetzee." Thesis, North-West University, 2004. http://hdl.handle.net/10394/91.

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The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

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Ford, Lawrence Randolph. "Exploration of Practice Managers' Decision-Making Strategies in a Managed-Care Paradigm." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3094.

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Practice managers are facing challenging expectations when deploying a managed-care paradigm. The problem addressed in this study was a gap in knowledge regarding practice managers' decision-making strategies that affect, or could be perceived to affect, a climate of excellence with business and client relationships, primary health care, physicians, and patients in a managed-care paradigm. The purpose of the qualitative exploratory study was to explore practice managers' decision-making strategies affecting primary health care, physicians, and patients. Guided by Simon's ideology of decision-making strategies in a management environment, the overarching research question and 3 subquestions centered on how practice managers delineate their decision-making strategies and how those strategies affect primary health care, physicians, and patients. To close the gap in knowledge, the study included (a) a homogeneous purposive sampling of 14 practice managers (n = 2, pilot study; n = 12, main study) as research participants; (b) face-to-face interviews with semistructured, open-ended questions to collect data; and (c) in vivo and pattern coding during data analysis. The study results indicated a need for change agents, interactions, partnerships, and accountability in a managed-care paradigm. Managing health care is complex and practice managers will continue to be challenged. Alliances between practice managers and stakeholders are recommended to meet those challenging expectations. As a result, positive social changes may be observed in improved access to primary health care, better health care treatments, and collaborative interactions in a managed-care paradigm.

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Alex, Theodore P. "An investigation of the impact of HealthChoices managed behavioral healthcare on the Lehigh Valley." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1999. http://www.kutztown.edu/library/services/remote_access.asp.

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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1999.
Source: Masters Abstracts International, Volume: 45-06, page: 2928. Typescript. Abstract precedes thesis as preliminary leaves iii-iv. Includes bibliographical references 122-127.

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Brudevold, Christine. "Assessment of capitated contract medicine arrangements in Hong Kong : an example of financial incentives and managed care in an unregulated environment /." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B20906791.

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McCollum, Denise M. "The Structural Response and Performance of General Hospitals in a Managed Care Environment." VCU Scholars Compass, 1998. https://scholarscompass.vcu.edu/etd/4943.

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The study purpose is to link hospital structure, represented by each hospital’s professional contingent, service mix, and inpatient capacity; and its environment, characterized by the penetration of managed care enrollees. The secondary purpose is to test the relationship between hospital structural change and subsequent hospital performance. The study employs a non-experimental panel design, with a sample of 1882 community hospitals (service type: general medical and surgical). Environmental variables are measured for the base year 1989. Hospital structural variables are measured for 1989 and 1994, with change variables computed. Performance variables are measured for 1989 and 1995, with change computed for cost measures. Hospital structural change is viewed as a dependent variable related to the environment, as well as an independent variable related to performance. Descriptive data are extracted from the American Hospital Association Annual Survey of Hospitals. Hospital cost performance data are from the Health Care Financing Administration Prospective Payment System Minimum Data Sets. Hospital mortality data for 1989 are from Medicare Hospital Mortality Information. HMO enrollment data are extracted from the Interstudy Edge and aggregated to metropolitan statistical area (MSA) level. Market competition data are from the 1989 Area Resource File. A Herﬁndahl-Hirschman index (HHI) is calculated for each hospital’s MSA. Analytical hypotheses are tested using ordinary least squares (OLS) technique. Results from Part 1 suggest that where HMO penetration was relatively high, sample hospitals tended to contain growth in their registered nurse (RN) staff between 1989 and 1994. Higher HMO penetration is also associated with more stabilization in occupancy rates, preventive services, and ambulatory workload. In contrast, market competition is associated with changes to a higher Medicare case-mix index (CMI), and increase in ambulatory visits. Results from Part 2 indicate positive associations between increased RN staff and hospital cost growth between 1989 and 1995. Hospitals which did not experience an increased CMI are similarly linked with cost growth. Alternatively, reduction in hospital bedsize is associated with more controlled growth in hospital cost per patient day. Several control variables display noteworthy associations with the variables of interest. Theoretical and management implications for community hospitals are discussed.

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Kaissi, Lana. "SOCIAL WORK PERSPECTIVES ON THE CONSTRAINTS OF MANAGED CARE AND MENTAL HEALTH TREATMENT." CSUSB ScholarWorks, 2019. https://scholarworks.lib.csusb.edu/etd/869.

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Approximately 46.6 million adults in the United States live with a mental illness as of 2017. Therefore, managed care being the system that facilitates access to mental health treatment needs to be addressed. Managed care (such as healthcare plans) seeks to facilitate healthcare service delivery by providing direction and guidance to utilization and prevention of services. The purpose of this qualitative study is to explore social work perspectives on the constraints of managed care as it impacts access to mental health treatment. This study conducted qualitative interviews through a non-random sample of professional colleagues of social workers in the in the manage care field. This study found five emerging themes including long wait times, lack of providers (to provide timely, effective mental health treatment), over diagnosing to justify services, profit-driven service delivery, and managed care not aligning with social work values. The implications of this study urge the need for accountability and consistency through policy change and reform.

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Angelotta, John Walton. "Clinical social workers' involvement in and adoption of managed mental health care technology." Case Western Reserve University School of Graduate Studies / OhioLINK, 1994. http://rave.ohiolink.edu/etdc/view?acc_num=case1057687689.

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Hooper, Tina L. "Analyzing the impact of job dissatisfaction among social workers in managed care." Thesis, Capella University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10164284.

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Employee job satisfaction is an ongoing concern in the field of social work. High caseloads, low compensation, and the lack of job security are sources of job dissatisfaction for novice and seasoned social workers in managed care settings. Specifically, the purpose was to determine if there is a correlation between high caseloads, the lack of job security, and low compensation and job dissatisfaction among novice (n = 24) managed care social workers and seasoned (n = 86) social workers in Texas and the surrounding areas. The emphasis of these factors, if not recognized and addressed through interventions by health care administrators, can lead to novice or seasoned managed care social workers’ dissatisfaction and within their position and careers with an ending result of desirable professional leaving the field of social work. Herzberg’s two-factor theory guided the study. The independent variables were selected for use in a multiple regression analysis at the .05 level of significance. No correlation was found between high caseloads and job dissatisfaction among novice social workers or between low compensation and job dissatisfaction among novice and seasoned social workers. High caseloads were correlated with job dissatisfaction among seasoned social workers. A correlation was found between the lack of job security and job dissatisfaction between novice and seasoned social workers. The research study collected data used in sealing the gap in the health care community by providing valuable information and directions for health care administrators to focus on in an attempt to reduce turnover, increase productivity, and improve the quality of patient care.

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Yang, Jie. "Incentives of Managed Care Insurance and Treatment Choices in Low-Risk Primary Cesarean Delivery." Thesis, Wayne State University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10929029.

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In response to climbing health care costs in the United States, many insurers and policy makers would like to eliminate waste in healthcare by steering spending toward the most cost-effective treatments. Obstacles to achieving this goal include identifying specific medical settings where overuse occurs, and then developing strategies to prevent overuse without harming patient welfare. My study examined childbirth, the number one reason for hospitalization in the US, where the overuse of medical resources primarily takes the form of nonmedically indicated cesarean deliveries.

The financial tools (physician payment differential and patient’s cost sharing) and other tools (utilization management, physician profiling, and practice guidelines) of managed care insurance create varied incentives that could affect behaviors of physicians and patients. Using data from the MarketScan commercial database, I proved that in a fee-for-service setting, physician’s financial incentives (physician payment differential) and patient’s financial disincentive (patient’s cost-sharing) affect treatment choices on childbirth delivery method, and other incentives from managed care insurance have little effect. My study also found that more restrictive nonfinancial tools in non-capitated HMOs which are expected to reduce the use of cesarean sections turn out to have little effect, while lower cost-sharing in non-capitated HMOs leads to more use of cesareans. It could provide two health policy implications: (1) health plans with generous benefits may need more restrictions and effective regulations aimed at cost control, and (2) raising patients cost-sharing may prove effective for managing medical expenses. Finally, a “What if” analysis sheds light on the likely effectiveness of various changes in managed care insurance design intended to reduce low-risk primary cesarean deliveries.

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Yildiz, Ozkan. "A Comprehensive Model For Measuring Health Care Process Quality: Health Care Process Quality Measurement Model (hpqmm)." Phd thesis, METU, 2012. http://etd.lib.metu.edu.tr/upload/12614318/index.pdf.

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Similar to the manufacturing sector, process improvement gains much attention in health care sector. Measuring process quality is one of the most important components of process improvement and numerous healthcare quality indicator models are developed to achieve this aim. Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures the quality of health care processes comprehensively. As a result, hospitals cannot compare quality of processes internally and externally. To bring a solution to the above problems, we developed Health Care Process Quality Measurement Model (HPQMM), and it is applied in three public hospital&rsquo
s laboratory and assessment processes. We observed that, the developed model determines weak and strong aspects of the processes, gives a detailed picture for the process quality, extends the quality aspects of existing models, and provides quantifiable information to hospitals to compare their processes with multiple organizations.

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Bopape, Susan Mothekoa. "The management of dyslipidemia in a private health care setting : a managed pharmaceutical care approach / Susan Mothekoa Bopape." Thesis, North-West University, 2004. http://hdl.handle.net/10394/483.

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The global anti-dyslipidemic market grew by 19% from 2000 to 2001, achieving sales of over $21 billion (Smith, 2004: 2). This market is currently well sewed by a number of effective and well-tolerated treatments. Lipid-lowering drugs are considered as the first choice drugs in control of dyslipidemias and they are well tolerated by most patients. As with many drug therapies, there should be a balance between the benefits of cholesterol lowering agents, increased medication cost and the overall risk of adverse drug reactions. According to Ballesteros (2001: 514), hypolipidemic drugs are consumed on a large scale and most consumers are elderly. This warrants a study of expenditure incurred because of inadequate prescribing of these agents. The general objective of this study was to determine the utilisation and cost of hypolipidemic drugs in the private health care environment in South Africa. A quantitative retrospective drug utilisation review was performed using a medicine claims database. Data for twenty-four consecutive months (May 1, 2001 to April 30, 2003) were used to determine and compare the utilisation patterns and cost of drugs associated with the management of dyslipidemia a year before (1st May 2001 to 30 April 2002) and a year after (1st May 2002 to 30 April 2003) the implementation of a medicine reference price system (MPL). Data analysis was done by calculating the average value, the standard deviation, effect size, and cost-prevalence indices. The results of this study revealed that hypolipidemic drugs constituted 2.70% (n = 21820911) and 2.78% (n =27277825) of the total number of all medicine items for the first and the second study years respectively. On the other hand, the total cost of all hypolipidemic drugs accounted for 6.33% (n= R3 097 604 602) and 6.23 % (n= R 4 053 280 295) of the total cost of all medicine items claimed during the first and the second study years respectively. The prevalence of generic hypolipidemic drugs accounted for 0.89% (n=589036) and 4.88% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study year respectively. Innovator drugs, on the other hand, constituted 99.1 1% (n=589036) and 95.11% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study years respectively. It was found that R23 694.5 and R603 277.36 could have been saved for generic bezafibrate and generic simvastatin respectively if they had been sold at ME'L prices. The total cost of generic hypolipidemic drugs accounted for 0.60% and 2.94%. The total cost of innovator hypolipidemic drugs accounted for 99.40% and 97.06% of the total cost of hypolipidemic drugs claimed during the first (n=R 196 076 050) and second (n=R 252 919 285) study year respectively. With respect to the prescribed daily dose, it was found that most prescriptions for individual hypolipidemic drugs did not conform to the defined daily dose. It was, however, found that most prescriptions whose prescribed daily dose was for one tablet once daily and whose strength was similar to the defined daily dose conformed to the defined daily dose. The conclusion is that there was an insignificant difference in both the prevalence and cost of hypolipidemic drugs a year before and after the implementation of MPL. It was further concluded that increased utilisation of generic hypolipidemic medicine items a year after the implementation of the MPL, could have been brought about by the introduction of generic simvastatin into the market as opposed to the implementation of the MPL. Recommendations for further studies will be formulated.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

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Smit, Corlee. "Aspects of drug usage in a section of the private health care sector of South Africa : A managed health care approach / C. Smit." Thesis, North-West University, 2008. http://hdl.handle.net/10394/4175.

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Background: According to the Council of Medical Schemes of South Africa (CMS, 2007:52), nearly seventeen percent of the total benefits paid during 2006 were for medicine. Medicine is thus a cost-driving contributor to total healthcare financing. There are various factors influencing and driving medicine usage and cost patterns, including inter alia provider preference, therapeutic committees, marketing and cost. Objectives: The purpose of this study was to identify the top twenty trade name products according to total cost and prevalence in a section of the private health care sector of South Africa, and to identify cost driving products. Methodology: A quantitative, retrospective drug utilisation review (DUR) study was performed on computerised medication records (medicine claims data) for two consecutive years (i.e. 2005 and 2006) that were obtained from a South African pharmaceutical benefit management company (PBM). The study population consisted of 1 218358 and 1 259 099 patients for 2005 and 2006 respectively. A total of 19 860 679 and 21 473017 medicine items that were claimed during 2005 and 2006 were included in the review. Descriptive statistics were used to describe the data, and were analysed using the Statistical Analysis System® SAS 9.1® programme. The cost prevalence index (CPI), developed by Serfontein (1989:180), was used as an indicator of the relative expensiveness of medicine. Resource- and activity driver products (cost driving products) were identified on the database by calculating the total cost of the product, the CPI of the product as well as the prevalence of the product. Variables for analysis included age, gender, prescriber and provider types. Resurts and discussion: A total number of 8 522 574 and 9 046 138 prescriptions were analysed, with an average of 2.33 ± 1.56 and 2.37 ± 1.58 items per prescription during 2005 and 2006 respectively. The average cost per prescription for the total database was R222.16 ± R463.13 for 2005 and R226.25 ± R557.49 for 2006. Members had to co-pay an average of R26.33 ± R102.70 per prescription in 2005 compared to R29.74 ± R103.96 per prescription in 2006. Children under the age of nine accounted for approximately 13% of the total study population, the adolescent age group < 9 and ≥ 19 years) represented 12%, age group three < 19 and ≥ 45 years) represented 38%, age group four < 45 and ≥ 59 years) represented 21% and the geriatric age group (patients older than 59 years) represented 16% of the total study population on the database. About 44% of the study population were male compared to 56% female patients. The top twenty trade name products ranked according to total cost represented about 13% (N=R1 893376 921.00 and N=R2 046 944382.50 in 2005 and 2006 respectively) of the overall medicine cost. The top five trade name products according to total cost for 2005 in descending order were Upitor 1 Omg and 20mg, Fosamax 70mg, Celebrex 200mg and Prexum 4mg. During 2006 the top five trade name products were similar except for Cipralex 10mg in the place of Celebrex 200mg. The CPls for all these products were above one; these products were also all activity drivers. The top twenty trade name products ranked according to prevalence represented about 11% (N=19 860679 and N=21 473074) of the total medicine prevalence for both study periods. The top five trade name products according to prevalence for both years contained Eltroxin 100mcg, Ecotrin 81 mg, Upitor 10mg and Alcophyllex syrup, with Myprodol capsules in 2005 and Mybulen tablets in 2006. Upitor 1 Omg was the only cost driver product in this list. General medical practitioners prescribed the largest quantity of medicine items and represented about 73% of all the medicine items on the database. The medicine prescribed by general medical prescribers accounted for 65% of the overall medicine expenditure on the database. Pharmacies can be seen as the main providers of medicine items. Pharmacies provided approximately 80% of the medicine items and represented over 91% of the total medicine expenditure. Cardiovascular agents were the main pharmacological group that represented the greatest percentage of the total medicine cost, about 19% in both study years. Cardiovascular agents were also positioned 1st according to prevalence and represented about 14% of the overall medicine prevalence in both the study periods. Conclusions and recommendations: Cost driver products can be seen as the products that drives medicine expenditure in the managed health care environment, thus driving the total cost of medicine treatment in the private health care sector of South Africa. Through the implementation of managed health care information- and management instruments medicine expenditure can be reduced. Recommendations for future research have been made.
Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

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Phillips, Kerry Megan. "The psychofortology of women undergoing infertility treatment at a privately managed health care unit." Thesis, Nelson Mandela Metropolitan University, 2008. http://hdl.handle.net/10948/729.

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Infertility, the inability to conceive a child or carry a pregnancy to birth, is an age-old concern, the anguish and disappointment of which is universal regardless of the etiology. Although technological advancement in the field of reproductive medicine has led to the possibilities of near miraculous procedures, infertility treatment offers the hope of conception without guaranteeing it and places the couple under tremendous emotional and financial strain. A moderate amount of research has explored the coping of individuals and the couple experiencing infertility, but has been primarily orientated to a clinical and medical focus as well as an exploration of the pathological symptoms that individuals may experience. This study has adopted a psychofortigenic focus and explored and described the coping (i.e., the coping resources and sense of coherence) and subjective well-being (i.e., satisfaction with life and happiness) of women undergoing infertility treatment. An exploratory descriptive research design was used and the participants were selected by means of non-probability purposive sampling. The sample consisted of 61women who were aged 30 years and older and required that they had received infertility treatment at a privately managed health care unit. Contextual and biographical data were gathered by means of a biographical questionnaire. Hammer and Marting’s (1988) Coping Resources Inventory was used to assess the participant’s coping resources. Antonovsky’s (1987) Orientation to Life Scale was used to measure the construct of Sense of Coherence. The Satisfaction with Life Scale by Diener, Emmons, Larsen and Griffin (1985) was used to assess respondents’ overall satisfaction with life while Kamman and Flett’s (1983) Affectometer-2 (AFM-2) was used to measure participants’ subjective happiness. The data were analysed using descriptive statistics and cluster analysis. The results of the CRI indicated a total coping resources score slightly below the mean of 50 as established by Hammer and Marting (1988). Results revealed that the highest mean score was obtained on the spiritual/philosophical subscale. Results from the SOC-29 indicated that the women sampled had an average Sense of Coherence. In terms of the construct of satisfaction with life as measured by the Satisfaction with Life Scale, the results indicated that the participants were slightly satisfied with their lives. Results from the AFM-2 revealed that the majority of participants experienced a below average feeling of happiness. Cluster analysis revealed three distinct clusters that differed significantly across the four measures.

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Surender, Rebecca Miriam. "Managed competition and the National Health Service : an evaluation of General Practice fundholding." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285536.

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Carter-Michaelson, Faith. "An exploratory study of San Bernardino County employees' knowledge about the limitations and provisions of their managed health care plans." CSUSB ScholarWorks, 1999. https://scholarworks.lib.csusb.edu/etd-project/1793.

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Saah, Peter Kenneth Jr. "Leaders who influence the attainment of Overall Medicare Star Ratings in Managed Care Organizations." Franklin University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=frank1596022516535652.

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Meyer, Elisabeth. "New perspectives on the role of information in health economics." Lohmar Köln Eul, 2009. http://d-nb.info/999222651/04.

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Webb, Matthew Aaron. "Modeling Individual Health Care Utilization." BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/8832.

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Health care represents an increasing proportion of global consumption. We discuss ways to model health care utilization on an individual basis. We present a probabilistic, generative model of utilization. Leveraging previously observed utilization levels, we learn a latent structure that can be used to accurately understand risk and make predictions. We evaluate the effectiveness of the model using data from a large population.

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Schiffel, Ottalee. "The usefulness of assurance services related to nonfinancial performance measures in the selection of healthcare insurance providers /." free to MU campus, to others for purchase, 2003. http://wwwlib.umi.com/cr/mo/fullcit?p3115589.

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Lindrooth, Richard C. "Selective contracting, cost sharing, and utilization management : a theoretical and empirical analysis of the market for health care /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/7463.

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Striegel, Mary. "A Paradigm Shift in the Golden Years The Transition from Federal Medicare to Managed Care Medicare." Youngstown State University / OhioLINK, 1999. http://rave.ohiolink.edu/etdc/view?acc_num=ysu998075386.

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Kelly-Shelby, Angela Mastracchio. "The collaboration of nurse practitioners and physicians in long-term care using a case-management model in a managed-care environment." [Pensacola, Fla.] : University of West Florida, 2005. http://purl.fcla.edu/fcla/etd/WFE0000038.

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Dissertations / Theses on the topic 'Managed health care model'

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