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The Welfare and Retirement Fund of the United Mine Workers of America (UMWA) is widely acknowledged as the most innovative effort at group health care in the United States in the twentieth century. Ivana Krajcinovic describes the establishment, operation, and demise of the Fund that brought mining families from the backwater to the forefront of medical care in less than a decade. Krajcinovic analyzes the success of the Fund over nearly three decades in providing high-quality cost-effective care to miners and their families. She also explains the irony of its dismantlement at the very moment when its innovations gained currency among mainstream commercial plans.
Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.
Most people don't understand health insurance, and insurance companies know it. Unfair denials, late payments, and hopeless confusion are the norm. At last there is a solution. In eight easy steps, Making Them Pay gives practical advice about the things that drive people crazy. Like: -Figuring out what health plans really say -Understanding what benefits they provide -Finding, and understanding, the exclusions -Determining what health plans really cost -How to talk to customer service, and other painful details -Easy ways to keep good records -Laws that can change your life-like the mandatory benefits laws in all fifty states -How to prepare successful appeals Along with this useful advice, Making Them Pay offers a much-needed sense of humor. It's filled with cartoons, sidebars, and vignettes that will make you laugh as you learn. Based on Rhonda D. Orin's extensive experience as a litigator, a journalist, and a mother fighting her own family's insurance battles, Making Them Pay is the book your health insurer doesn't want you to read. "A compact reference [that] simplifies a convoluted subject. -
The origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care.
While much has been written about immigrant traditions, music, food culture, folklore, and other aspects of ethnic identity, little attention has been given to the study of medical culture, until now. In Medical Caregiving and Identity in Pennsylvania’s Anthracite Region, 1880–2000, Karol Weaver employs an impressive range of primary sources, including folk songs, patent medicine advertisements, oral history interviews, ghost stories, and jokes, to show how the men and women of the anthracite coal region crafted their gender and ethnic identities via the medical decisions they made. Weaver examines communities’ relationships with both biomedically trained physicians and informally trained medical caregivers, and how these relationships reflected a sense of “Americanness.” She uses interviews and oral histories to help tell the story of neighborhood healers, midwives, Pennsylvania German powwowers, medical self-help, and the eventual transition to modern-day medicine. Weaver is able to show not only how each of these methods of healing was shaped by its patrons and their backgrounds but also how it helped mold the identities of the new Americans who sought it out.
Today's heath care marketplace is highly competitive, requiring managed care providers to contract with dozens of insurers to survive. Each of these contracts comes with their its unique terms and conditions-making the contracting process overwhelmingly complex and giving many health care executives major headaches. Written by three of the country's leading health care consultants and attorneys, Managed Care Contracting is the first book to offer executives with no legal background practical, step-by-step advice on how to create winning contracts between health care organizations, payers, and employers. In straightforward language, free of legalese and jargon, this much-needed resource demystifies managed care contracting and prescribes some critical advice for hospital and physician group practice executives. The authors present helpful guidelines for evaluating the various types of managed care contracts and explain the most significant terms and concepts executives are likely to encounter. A treasure trove of information for health care executives no matter what their experience level, Managed Care Contracting Examines how to develop a contracting strategy Reviews the fundamentals of negotiating the contract Frames the key steps in the contracting process Provides a managed care contract negotiations checklist Dissects sample hospital and physician contracts Analyzes the contract risk factors by the type of payment explores the implications of changing financial incentives Outlines the most up-to-date information in the regulatory environment Includes illustrative examples and helpful tables and chartsFor health care executives who are just beginning the complex contracting process and for the more experienced who require the most current information on the topic, Managed Care Contracting provides the knowledge and tools they need to succeed. "Managed Care Contracting is a very timely
When Dr. Brownes partner retires, his practice is taken over by Dr. Forbes Q. Hazzig, who becomes a zealot for a managed care revolution of marketplace medicine. Browne and his associate Dr. Kennes receive irrational, discordant information from healthcare experts, consultants and economists. Browne learns that rhetoric of a mass movement must be as erroneous as possible promising a vague, glorious future. Hazzig grows immensely rich and gains enormous power relying on intimidation and coercion. Joanna Brownes exhibition of J.M.W. Turner becomes a thrilling success, yet Hazzigs wife succeeds in eliminating Joannas position at East Valley Museum of Art. Joanna must accept a position at a distant university; her absence devastates Browne. Browne and Kennes discover managed care was based on a Washington bureau hoax, the health maintenance strategy of 1973: an irrational mass movement, a mass hysteria. Hazzig plots to humiliate and ruin the two doctors; each threat goes awry. Hazzig is discredited; his illusory wealth collapses. Reunited with Joanna, Dr. Browne receives a disturbing invitation to return to East Valley to be recognized with Dr. Kennes for their efforts to expose the folly of managed care. Browne is reluctant to relive his lonely, troubled, distressed past.
Drawing from a diverse range of interdisciplinary voices, this book explores how spaces of care shape our affective, material, and social forms, from the most intimate scale of the body to our planetary commons. Typical definitions of care center around the maintenance of a livable life, encompassing everything from shelter and welfare to health and safety. Architecture plays a fundamental role in these definitions, inscribed in institutional archetypes such as the home, the hospital, the school, and the nursery. However, these spaces often structure modes of care that prescribe gender roles, bodily norms, and labor practices. How can architecture instead engage with an expanded definition of care that questions such roles and norms, producing more hybrid entanglements between our bodies, our collective lives, and our environments? Chapters in this book explore issues ranging from disabled domesticities and nursing, unbuilding whiteness in the built environment, practices and pedagogies of environmental care, and the solidarity networks within ‘The Cloud’. Case studies include Floating University Berlin, commoning initiatives by the Black Panther party, and hospitals for the United Mine Workers of America, among many other sites and scales of care. Exploring architecture through the lenses of gender studies, labor theory, environmental justice, and the medical humanities, this book will engage students and academics from a wide range of disciplines.