December 1997

Responding to market pressures, many health plans are easing the referral process or eliminating it altogether. Will this trend result in higher costs and poorer medicine?

By Jean Lawrence

Some say it’s too bad the managed care industry can’t get together on a single accrediting and quality-rating agency for health plans. But the Joint Commission’s president says it may actually be a blessing.
Last summer the American Diabetes Association proposed stronger screening guidelines months before the CDC reported the disease at an all-time high. Now managed care must decide whether to follow through.

Contributing editor Chuck Appleby is based in Benicia, Calif. Among his previous articles for Managed Care are “Labor Unions for Doctors” in September 1996 and “Helping Doctors Listen Better” in December 1996.

Whether they are $2 or $10 or nothing, HMO copayment amounts aren’t just picked out of thin air. Because so much — from utilization rates to physician revenue — is at stake, setting copayments is a complicated process.

Michael D. Dalzell

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