Designing a Model of Managed Care in Health Care System of Iran

Subject Areas : Futurology

B.  Delgoshaei ¹ (ندارد)
M.  Ghasemi ² (نویسنده مسئول یا طرف مکاتبه)

Received: 2008-03-26 Accepted : 2008-09-30 Published : 2009-10-23

Keywords: managed care, integrated care, coordinated care, Health Action Zones, health care system,

Abstract :

the managed care is an example of the new system of care taking which is designed to control the careexpense, manage the utilization of the services, and evaluate the services done for the improvement ofthe quality and make a proper cost- effectiveness through the managed care organization .the mostimportant objective is, study of planning, organization and control in selected country and designing amodel for Iran.it is a practical research and trough a comparative – descriptive procedure like those performed in theUSA, Australia, UK, Malaysia. The utilization of the descriptive statistics for the analysis of thequestionnaire by means of Delphi technique is done.in order to encourage the care taking of the patients in a proper way and to increase the economicaleffectiveness of the system in the investigated countries , some programs like" Integrated Care" are putin to practice, so that the expenses are controlled to a large extent. Primary care groups in UK are thesimplest form and managed care in the USA is the most complex process the integrated care. Planning,organizing and control of this model is accepted by mean 78.2 ± 1.15, 70.14 ± 1.6 and78.76 ± 3.6(Pvalu .05).it seems that, health care expenditure could be reduced considerably through establishing managedcare organizations (MCOs). So، this model can create a new way of insurance and health careservices.