tci Medicare Compliance & Reimbursement - 2004 Issue 4
Medicare+Choice: SENIORS IN FOR-PROFIT PLANS NOT DENIED HIGH-COST CARE
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Article Overview
This article reports on a New England Journal of Medicine study of Medicare managed care enrollment and the use of common high-cost surgical procedures in for-profit versus nonprofit plans. It is relevant to readers tracking Medicare+Choice policy, managed care utilization patterns, and broader questions about access to care and spending control. The article presents the study context, the populations examined, the procedure categories considered, and the authors’ general interpretation of the findings.
Why This Topic Matters
It helps readers understand how managed care ownership type may relate to access patterns for costly procedures within Medicare, a topic important for policy, utilization review, and health plan analysis.
What You Will Learn
- How a Medicare managed care study compared for-profit and nonprofit plan access patterns.
- What broad categories of surgical services were examined in the analysis.
- How the study was framed in relation to access to care and spending control.
- Which organization and publication reported the study findings.
Who Should Read This
- Medical coders
- Health information professionals
- Compliance staff
- Healthcare administrators
- Policy analysts
- Managed care professionals
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