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Cost Management

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Healthcare Management

Part of the book series: Springer Texts in Business and Economics ((STBE))

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Abstract

In healthcare, a variety of different measures and instruments can be applied to manage the cost of healthcare. The following chapter will discuss the usefulness and effectiveness of gatekeeping, formularies and utilization reviews. These three cost management tools are especially relevant to Managed Care. In gatekeeping, most treatment episodes begin with a visit to an individually selected physician, the gatekeeper, who ensures a coordinated and cross-sectorial treatment process. Formularies are used to explicitly define which services are paid for and apply utilisation reviews as a key instrument.

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Notes

  1. 1.

    In the scope of the utilisation review, the sub-form of drug utilisation reviews plays an important role. 93.8% of all HMOs use this form of utilisation review (Sanofi 2015).

  2. 2.

    In the US there are two types of nurses with vastly different qualification profiles. Registered nurses (RNs) complete a degree, while nurse practitioners complete a professional training course.

  3. 3.

    Maximum length of stay, usually based on the ICD-10.

  4. 4.

    In practice, in the US many consulting firms have been established in recent years, which specialise in carrying out utilisation reviews and management. Their crucial advantage is that they have very large quantities of comparable figures and can thus better assess whether physicians or treatments diverge from the norm (MCO).

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Authors and Affiliations

  1. Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany

    Volker Eric Amelung

  2. Institute of Health Sciences Research INAV GmbH, Berlin, Germany

    Volker Eric Amelung

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  1. Volker Eric Amelung
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Amelung, V.E. (2019). Cost Management. In: Healthcare Management. Springer Texts in Business and Economics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59568-8_12

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  • DOI: https://doi.org/10.1007/978-3-662-59568-8_12

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