Advertisement

Contract Design

  • Volker Eric Amelung
Chapter
Part of the Springer Texts in Business and Economics book series (STBE)

Abstract

One of the most important preconditions for high-quality and economically effective treatment results is a selection of suitable service providers with whom an MCO concludes supply contracts (selective contracting). The conclusion of selective contracts is so significant for managed care and healthcare management that it is considered crucial to the definition of managed care by not only the authors of this book, but the literature supports this claim as well.

Literature

  1. Amelung, V. E. (2007). Integrierte Versorgung – von Pilotprojekten zur “wirklichen” Regelversorgung. Gesundheits- und Sozialpolitik, 1(2), 10–13.CrossRefGoogle Scholar
  2. Andre, F. E., Booy, R., Bock, H. L., et al. (2008). Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organization, 86(2), 140–146.CrossRefGoogle Scholar
  3. BAG [Bundesamt für Gesundheit]. (2015). FAQ zur Kostenbeteiligung. Accessed July 20, 2015, from http://www.bag.admin.ch/themen/krankenversicherung/04114/04285/?lang=de
  4. Bauer, J., Neumann, T., & Saekel, R. (2009). Zahnmedizinische Versorgung in Deutschland Mundgesundheit und Versorgungsqualität – eine kritische Bestandsaufnahme. Bern: Hans Huber Verlag.Google Scholar
  5. Bindman, A. B., Grumbach, K., Vranizan, K., et al. (1998). Selection and exclusion of primary care physicians by managed care organizations. JAMA: The Journal of the American Medical Association, 279, 675–679.CrossRefGoogle Scholar
  6. Blum, J. D. (1997). Economic credentialing moves from the hospital to managed care. In P. R. Kongstvedt (Ed.), Readings in managed health care (pp. 108–115). Gaithersburg: Aspen.Google Scholar
  7. BMG. (2015, June 23). (Bundesministerium für Gesundheit). Gesetzliche Krankenversicherung – Endgültige Rechnungsergebnisse 2014.Google Scholar
  8. Bodenheimer, T. S., & Grumbach, K. (1995). Understanding health policy – A clinical approach. Norwalk: Appleton & Lange.Google Scholar
  9. Brooke, S., Perler, A., Dmonici, F., et al. (2008). Reduction of in-hospital mortality among California hospitals meeting Leapfrog evidence-based standards for abdominal aortic aneurysm repair. Journal of Vascular Surgery, 47(6), 1155–1164.CrossRefGoogle Scholar
  10. Claxton, G., DiJulio, B., Whitmore, H., et al. (2011). Health benefits in 2010: Premium rise modestly, workers pay more toward coverage. Health Affairs, 29(10), 1942–1950.CrossRefGoogle Scholar
  11. Crossen, F. J., & Tollen, L. A. (2010). Partners in health, how physician and hospitals can be accountable together. San Francisco, CA: Jossey-Bass.Google Scholar
  12. Feldman, R., Chan, H., Kralewsky, J., et al. (1990). Effects of HMOs on the creation of competitive markets for hospital services. Journal of Health Economics, 9, 207–222.CrossRefGoogle Scholar
  13. Feldman, H. R., Alexander, R., Greenberg, M. J., Jaffee-Ruiz, M., McBride, A., McClure, M., & Smith, T. D. (2012). Nursing leadership: A concise encyclopaedia (2nd ed.). New York: Springer.Google Scholar
  14. Feldstein, P. J. (1993). Health care economics (4th ed.). Albany, NY: Delmar.Google Scholar
  15. Ghosh, A., Philiponis, G., Bewley, A., Ransom, E. R., & Mirza, N. (2016). You can’t pay me to quit: The failure of financial incentives for smoking cessation in head and neck cancer patients. The Journal of Laryngology & Otology, 130, 278–283.CrossRefGoogle Scholar
  16. Goldman, D. P., Joyce, G. F., Escarce, J. J., et al. (2004). Pharmacy benefits and the use of drugs by chronically ill. JAMA: The Journal of the American Medical Association, 291(19), 2344–2350.CrossRefGoogle Scholar
  17. Hajen, L., Paetow, H., & Schuhmacher, H. (2011). Gesundheitsökonomie: Strukturen – Methoden – Praxis (6th ed.). Stuttgart: Kohlhammer.Google Scholar
  18. Henderson, J. W. (2011). Health economics and policy (5th ed.). South Western: Educational Publishing.Google Scholar
  19. IOM [Institute of Medicine]. (1999). To err is human: Building a safer health system. Washington, DC: Institute of Medicine.Google Scholar
  20. Janus, K. (2003). Managing health care in private organizations. Transaction costs, cooperation and modes of organization in the value chain. Frankfurt am Main: Peter Lang.Google Scholar
  21. Jensen, G. A., Morrisey, M. A., Gaffney, S., et al. (1997). The new dominance of managed care: Insurance trends in the 1990s. Health Affairs, 16(1), 125–136.CrossRefGoogle Scholar
  22. Kazmir, J. L. (2008). Health care law. New York: Delmar.Google Scholar
  23. KBZV [Kassenzahnärztliche Bundesvereinigung]. (2016). Jahrbuch 2016. Statistische Basisdaten zur vertragszahnärztlichen Versorgung. Accessed March 13, 2018, from http://www.kzbv.de/kzbv-jahrbuch-2016.media.1259913f4630871f8765c78e785fd2f2.pdf
  24. KFF [Kaiser Family Foundation]. (2012). Employer health benefits 201, annual survey. Menlo Park/Chicago: Kaiser Foundation & HRET. Accessed March 13, 2018, from http://ehbs.kff.org/pdf/2012/8345.pdf
  25. KFF [Kaiser Family Foundation]. (2015). Preventive services covered by private health plans under the Affordable Care Act. Accessed March 13, 2018, from http://files.kff.org/attachment/preventive-services-covered-by-private-health-plans-under-the-affordable-care-act-fact-sheet
  26. Knight, W. (1998). Managed care – What is it and how it works. Gaithersburg: Aspen.Google Scholar
  27. Koenig, H. G., King, D. E., & Carson, V. B. (2012). Handbook of religion and health (2nd ed.). New York: Oxford University Press.Google Scholar
  28. Kongstvedt, P. R. (2013). Essentials of managed health care (6th ed.). Burlington, VT: Jones & Bartlett.Google Scholar
  29. Kühn, H. (1997). Managed care – Medizin zwischen kommerzieller Bürokratie und Integrierter Versorgung (WZB-Paper), Berlin.Google Scholar
  30. Leapfrog Group. (2013). What does Leapfrog ask hospitals? Accessed February 15, 2013, from http://www.leapfroggroup.org/patients/hospitals_asked_what
  31. McGlynn, E. A., Asch, S. M., Adams, J., et al. (2003). The quality of health care delivered to adults in the United States. The New England Journal of Medicine, 348(26), 2635–2645.CrossRefGoogle Scholar
  32. Newhouse, J. P. (1993). Free for all? Lessons from the RAND health insurance experiment (2nd ed.). Boston, MA: Harvard University Press.Google Scholar
  33. NIHCM. (2012, July). The concentration of health care spending. Accessed March 13, 2018, from http://www.nihcm.org/pdf/DataBrief3percent20Final.pdf
  34. OECD. (2016). OECD health data. Accessed March 13, 2018, from http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#
  35. Patel, M. S., Asch, D. A., Troxel, A. B., Fletcher, M., Osman-Koss, R., Brady, J., et al. (2016). Premium-based financial incentives did not promote workplace weight loss in a 2013-15 study. Health Affairs, 35(1), 71–79.CrossRefGoogle Scholar
  36. Peden, A. H. (2012). Comparative health information management (3rd ed.). Delmar: Cengage Learning.Google Scholar
  37. Porter, M. E., & Guth, C. (2012). Chancen für das deutsche Gesundheitssystem: Von Partikularinteresse zu mehr Patientennutzen. Berlin: Springer.CrossRefGoogle Scholar
  38. Porter, M., & Teisberg, E. (2006). Redefining health care – Creating value-based competition on results. Boston, MA: Harvard Business School Press.Google Scholar
  39. Pronovost, P., Thompson, D. A., Holzmueller, C. G., et al. (2006). Impact of the Leapfrog Group’s intensive care unit physician staffing standard. Journal of Critical Care, 22, 89–96.CrossRefGoogle Scholar
  40. Qian, F., Lustik, S. J., Diachun, C. A., Wissler, R. N., Zollo, R. A., & Glance, L. G. (2011). Association between Leapfrog safe practices score and hospital mortality in major surgery. Medical Care, 49(12), 1082–1088.Google Scholar
  41. Shi, L. (2007). Managing human resources in health care organizations. Sudbury: Jones & Bartlett.Google Scholar
  42. Shi, L., & Singh, D. A. (2012). Delivering healthcare in America: A systems approach (5th ed.). Sudbury: Jones & Bartlett.Google Scholar
  43. Solberg, L. I. (1998). Prevention in managed care. In P. R. Kongstvedt & D. W. Plocher (Eds.), Best practice in medical management. Gaithersburg: Aspen.Google Scholar
  44. Sorkin, A. L. (1992). Health economics (3rd ed.). New York: Lexington Books.Google Scholar
  45. Waldman, J. D., Yourstone, S. A., & Smith, H. L. (2003). Learning curves in health care. Health Care Management Review, 28(1), 41–54.CrossRefGoogle Scholar
  46. Young, M. P., & Birkmeyer, J. D. (2000). Potential reduction in mortality rates using an intensivist model to manage intensive care units. Effective Clinical Practice, 2000(6), 284–289.Google Scholar
  47. Zelman, W., & Berenson, R. A. (1998). The managed care blues & how to cure them. Washington, DC: Georgetown University Press.Google Scholar
  48. Zwanziger, J., & Meirowitz, A. (1998). Strategic factors in hospitals for HMO and PPO networks. In M. A. Morsey (Ed.), Managed care and changing health care markets (pp. 77–94). Washington, DC: AEI Press.Google Scholar
  49. Zweifel, P., Breyer, F., & Kifmann, M. (2009). Health economics (2nd ed.). Heidelberg: Springer.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Volker Eric Amelung
    • 1
    • 2
  1. 1.Institute for Epidemiology, Social Medicine and Health Systems ResearchHannover Medical SchoolHannoverGermany
  2. 2.Institute of Health Sciences Research INAV GmbHBerlinGermany

Personalised recommendations