Quote:
Briefly, our findings suggest that in contrast to finding more integrated,
continuous care, in the U.S., instead of providing better access to a wide range of services
through a single entry point, Managed Care uses the single entry point to prevent access.
In Canada, integration severed by constant restructuring, competitive “tendering” and
funding (i.e., staffing) cutbacks. Evidence of more accountable and appropriate care was
lacking revealing first, that evidence based practices were often a smoke-in-mirrors for
cutbacks, and second, greater accountability meant more risks being shifted to nurses and
doctors – through their providing more care for free. We also found that Managed Care
meant more rationing of both the access to and amount of care – the former differed
across our two countries but the latter was surprisingly similar. This revealed the extent
to which U.S. style Managed Care has been integrated into Canadian health care
institutions.
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this comes from a pretty interesting comparative sociological paper:
The Orientation of Professionals in Health Care Organizations in France, Canada, and the U.S.: Clients, Communities and Bureaucracies
Ivy Lynn Bourgeault, Ivan Sainsaulieu, Kristine Hirschkorn
what's interesting is the comparative approach, the focus on the interaction between insurance regime and medical organization--the differences between which become really apparent in reading these results. this interaction has considerable impace on both professional activities/trajectories and the quality of care. the central finding are in the paragraph i excerpted above.
if you want, pm me with an email address and i can send you the pdf of the article.
what's particularly good is the bibliography...if you're inclined to the game of chasing footnotes, you may also be inclined to run into actual data.
this compliments some of the higher-order arguments above that have been presented with at least some actual information, as opposed to the usual recycling of memes. the difference is that this paper---and there are others--i could barrage you with them---focus on the micro registers.
there is a direct link between quality of care and insurance regime.
what managed care says and what it does are very different from each other.
draw your own conclusions---but sooner or later, you have to start looking at evidence, thinking about how it's put together what the arguments are, how they connect to the evidence---you know, read critically.
one would hope anyway.