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Health Care Regulation in AmericaComplexity, Confrontation, and Compromise$
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Robert I. Field

Print publication date: 2006

Print ISBN-13: 9780195159684

Published to Oxford Scholarship Online: September 2009

DOI: 10.1093/acprof:oso/9780195159684.001.0001

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Regulation and Administration of Health Care Finance

Regulation and Administration of Health Care Finance

(p.74) 4 Regulation and Administration of Health Care Finance
Health Care Regulation in America

Robert I. Field

Oxford University Press

This chapter considers the financing of health care. It explains the history of private health insurance, including favorable tax and regulatory provisions that have sustained it over the years, and of public programs, including Medicare, Medicaid, and the State Children's Health Insurance Program. It also reviews the nature and evolution of managed care as an increasingly dominant form of coverage. The oversight of health care finance is extremely complex with an intricate and uncertain balance between federal and state authority. At the same time, payers, both pubic and private, have come to exert a large and growing influence over the actual provision of clinical care. The chapter ends with a discussion of perennial policy conflicts, including those between governmental and private financing, over intrusions by payers into clinical decision making, and over the seemingly intractable coverage gap for about 15 percent of the population.

Keywords:   health insurance, Blue Cross, managed care, Medicare, Medicaid, prospective payment

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