Book contents
- Frontmatter
- Contents
- Preface
- Biographies
- Notices
- Acknowledgements
- List of abbreviations
- Reviews
- Introduction: Overview and purpose
- Section 1 Paradigms of international policies
- Section 2 The failure of the aid paradigm: poor disease control in developing countries
- Section 3 Impact of international health policies on access to health in middle-income countries: some experiences from Latin America
- Section 4 Determinants and implications of new liberal health policies: the case of India, China and Lebanon
- Section 5 Principles for alternative, publicly oriented health care policies, planning, management and delivery
- Section 6 A public health, strategic toolkit to implement these alternatives
- 17 Person-centred care: a key to strengthening health care and systems in low- and middle-income countries?
- 18 Improving access
- 19 Improving clinical decision making
- 20 Reorienting academic missions: how can public health departments and public health teaching in particular best support access to good quality comprehensive health care?
- Conclusions
- Glossary
- Index
- References
19 - Improving clinical decision making
Published online by Cambridge University Press: 06 December 2010
- Frontmatter
- Contents
- Preface
- Biographies
- Notices
- Acknowledgements
- List of abbreviations
- Reviews
- Introduction: Overview and purpose
- Section 1 Paradigms of international policies
- Section 2 The failure of the aid paradigm: poor disease control in developing countries
- Section 3 Impact of international health policies on access to health in middle-income countries: some experiences from Latin America
- Section 4 Determinants and implications of new liberal health policies: the case of India, China and Lebanon
- Section 5 Principles for alternative, publicly oriented health care policies, planning, management and delivery
- Section 6 A public health, strategic toolkit to implement these alternatives
- 17 Person-centred care: a key to strengthening health care and systems in low- and middle-income countries?
- 18 Improving access
- 19 Improving clinical decision making
- 20 Reorienting academic missions: how can public health departments and public health teaching in particular best support access to good quality comprehensive health care?
- Conclusions
- Glossary
- Index
- References
Summary
Part 1: Non-managed care techniques to improve clinical practice
Introduction
In recent years managed care became a promise of cost control and reduction of unnecessary services utilization, especially in countries with very limited resources. Most LMICs included it early in their reform packages (Tollman et al., 1990). In spite of scarce empirical evidence on the implementation of managed care techniques in this setting (Luck & Peabody, 2002) and intense debates surrounding their introduction in countries such as the USA (Christianson et al., 2005; Simonet, 2005), these techniques were increasingly exported to LMICs.
In this chapter we briefly analyze the results of the introduction of managed care techniques in different environments, explore issues related to the resulting loss of autonomy in clinical practice and offer alternative techniques to improve quality of health care.
What is managed care and what are its results?
The literature offers different approaches and definitions of managed care, probably because it does not convey one single, common concept, but a set of principles and interwoven practices (born in the 1980s in the USA to control costs).
Managed care techniques aim at providing incentives for productivity and efficiency while improving quality of services. They should be distinguished from the organizations which implement them. In this chapter we will attempt to focus on the former and address, in the first instance, clinical mechanisms designed to improve clinical decision making.
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- International Health and Aid PoliciesThe Need for Alternatives, pp. 225 - 239Publisher: Cambridge University PressPrint publication year: 2010