Exporting managed care: Asian experiments

Abstract

Following managed care saturation in the US market, and because of limited prospects in Europe, managed care made some headway in Latin America and Southeast Asia.The following paper compares a general concept, "managed care", across countries, and shows that it has gained acceptance in certain territories (e.g. Hong Kong, the Philippines), but not in others. Managed care is defined as processes or techniques used by any entity that delivers, administers and/or assumes risk for health services in order to control or influence the quality, accessibility, utilization, costs and prices, or outcomes of such services provided to a defined population (American Medical Association, 1999). The first part of the paper reviews specific experiences (Indonesia, the Philippines, Malaysia, Hong Kong, Singapore), and is followed by a summary of difficulties that Managed Care encountered in Asia. Among these are rising public defiance and physician opposition.

Proposing a Physical Model for Malaysian Health Plan Data

“…As a result from this effort, healthcare financing models such as fee-for-service, health insurance and Managed Care Organization (MCO) have come into existence [5]. Studies by [4] revealed the participation of cooperatives, insurance companies, for-profit and not-for-profit companies into the MCO arena have contributed to the various MCO features as witnessed today. These features include independent practice association (IPAs), panel provider organizations and Health Maintenance Organizations (HMO).…”

“…Increase in healthcare cost has influenced governments and organizations globally to resort to possible alternatives [5,1,3,4]. Efforts have been initiated in Malaysia to produce an alternative system which exhibits efficient cost controlling capabilities and caters for Malaysia's unique requirements and culture [5].…”

“…IT was perceived as the main player among MCO tools that could provide an equilibrium between quality health care and MCO's continuous survival [5,4].…”

A Semistructured Data Approach to Heterogeneous Health Plan Data in Malaysian Managed Care Organizations

“…The gradual rise in health care cost and the expectation that the cost expended for employees' health conditions could be decreased or controlled is the primary reason for this inclination [4,1,2,3]. With the gradual growth of the Managed Care Organization (MCO) market [2,3], this inclination could become the future mechanism of Malaysian health care. Nevertheless, this new option is suffering from high competition within its market.…”

“…MCO tools were perceived to be an important factor in reaching an acceptable equilibrium between quality health care and securing the existence of MCOs. One of these tools is information technology (IT) [4,3].…”