Managed Care: What It Is and How It Works

Healthcare Financial Management, Jan, 2004 by Lyndon T. Castro

Managed Care: What It Is and How It Works offers an easy-to-read explanation of the history, current approaches, regulations, and future direction of managed health care. It also provides readers with a clear explanation or the reasons for managed care and how the entire system works, including the relationships among insurers, healthcare providers, the government, and members. The author uses frequent examples, diagrams, and illustrations to aid reader comprehension throughout.

Kongstvedt's target audience consists of individuals new to the concepts of managed care, as well as individuals with a general interest in the broad operating mechanisms of managed care. The book is written as a primer for novices, with a general overview or summary level of information. It would be ideal for an introductory seminar in managed health care. In particular, the book would suit clinicians not planning to be technical administrators, but wishing to gain a greater understanding of the managed ca re market.

The author is a well-published expert in health care administration, and this is evidenced by the clarity of information presented. Each important managed care topic is presented in a concise and condensed form. The book's limitations might be that little was discussed about the imports nee and relevance of risk adjustment approaches and the pathways and roles among the various levels of regulatory agencies. Overall, however, the book is cohesive, coherent, and logical in its presentation of information.

Lyndon T. Castro, CHFP, RHU, chief research officer, Intellispect Corp., Alta Loma, Calif., and a member of HFMA's Southern California Chapter.