Peter Kongstvedt provides an authoritative and comprehensive overview of the key strategic, tactical, and operational aspects of managed health care and health insurance. With a primary focus on the commercial sector, the book also addresses managed health care in Medicare, Medicaid, and military medical care. An historical overview and a discussion of taxonomy and functional differences between different forms of managed health care provide the framework for the operational aspects of the industry as well.

Managed Care

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.

Essentials of the U.S. Health Care System, Fifth Edition is a clear and concise distillation of the major topics covered in the best-selling Delivering Health Care in America by the same authors. Designed for undergraduate and graduate students in programs across the health disciplines, Essentials of the U.S. Health Care System is a reader-friendly, well organized resource that covers the major characteristics, foundations, and future of the U.S. health care system. The text clarifies the complexities of health care organization and finance and presents a solid overview of how the various components fit together.

Essentials of Health Care Finance stands firmly in its place as the leading textbook on healthcare finance. No other text so completely blends the best of current finance theory with the tools needed in day-to-day practice. Useful for all course levels as well as a professional reference, this text offers a comprehensive introduction to the field. The Seventh Edition has been thoroughly revised to reflect the current economic environment in the healthcare industry, with thoughtful descriptions and ‘real-world’ examples. As the not-for-profit health care sector has increasingly come under attack by legislators seeking new sources of tax revenue, this edition also features a new chapter on assessing community benefits including an examination of the new Schedule H of the IRS 990 form. Ancillary instructor materials for the Seventh Edition have been significantly expanded and updated. PowerPoint lecture slides now include selected examples from the chapters. Electronic versions of many of the charts and tables in the chapters are provided to enable the instructor to re-create and modify existing examples. An expanded set of test questions with detailed answers will be provided for each chapter. New excel spreadsheets for selected chapters will be created to help both the students and the instructors perform a variety of financial analysis tasks with spreadsheet templates. The instructor’s manual has been revised to include key learning points, chapter overviews, and guidelines for class discussion.

This collection of readings is a companion To The Essentials of Managed Health Care, Second Edition. These articles, taken from four Aspen journals (Managed Care Quarterly, Health Care Management Review, Journal of Health Care Finance, and Quarterly Management in Health Care) provide indepth coverage of key issues and topics in managed care.