Managed Care: What It Is and How It Works.

Managed Care: What It Is and How It Works

Knight W. Gaithersburg, MD 20878, Aspen Publishers Inc, 1998, paperback, 160 pp, $29.

The primary objective of this book is to introduce managed care concepts and principles to professionals who are unfamiliar with this delivery system. The author is a health care consultant who wrote the book for students in undergraduate, graduate, and postdoctoral education programs and professional and corporate training programs.

The author begins by presenting the history and development of managed care. The chapters that follow discuss the infrastructure of managed care and provider networks, measuring and ensuring quality of care, and regulatory and legal issues in the managed care environment. The author clearly states that managed care has not been developed consistently throughout the country and that the concept varies from region to region. This allows readers to recognize the key elements in their region and understand how those elements may be applied to a health care organization.

Each chapter has a list of learning objectives and key terms. The key terms are relevant to anyone who has regular dealings with or within managed care environments. Discussion questions and chapter references are presented at the end of each chapter along with suggested readings. For the most part, the references listed are from current journals and will enable students to pursue further study and investigation. The author also mentions the topic "centers of excellence," which is rapidly becoming a significant area of focus in competitive managed care markets.

Readers who wish to promote the growth and development of a health care organization can use the material presented, along with a more rigorous marketing text, to initiate a marketing plan. Some of the marketing topics that are briefly discussed include market overview, economic profile, competitive analysis, business community profile, and provider assessment. The author also provides information on compensation, including discounted fee-for-service, relative-value-based fee schedules, the resource-based relative value system (RBRVS), case rates, per diems, capitation, and diagnosis-related groups (DRGs). A chapter appendix includes a sample primary care physician contractual agreement, providing the reader with an opportunity to evaluate how some agreements are formulated.

The book would be recommended reading to undergraduate students who are currently in education programs for the health care professions and are planning to enter the workforce soon. The concepts will allow the reader to gain familiarity with terms commonly used in the health care arena. For students in graduate business programs that have a health care concentration, the book shows how the health care professions have changed and what elements are currently influencing the health care system. The book is introductory and, therefore, is not recommended as a stand-alone text for a college course. However, it would provide an excellent supplement to use with additional texts, journal articles, and reference materials.

Mark A Brimer PhD, PT Holmes Regional Medical Center Melbourne, Fla

Dr Brimer works in the Department of Rehabilitative Services. His research interests include health care management and administration.