The Complete Idiot's Guide to Managed Health Care (Complete Idiot's Guides)

Rating:
Summary: Excellent consumer's guide to health care in the USA.
Review: This is an intelligent consumer's guide to health care as it exists in the United States. I hope the series title "Complete Idiot's Guide" does not discourage readers. There is a wonderful line on page 23, which sets the tone for the book, "A patient is given care, a consumer buys care." The book then instructs the reader on how to get the most from his or her managed care health insurance coverage. Definitions of terms such as "capitation", "gatekeeper", "PPO", and "carve-outs" are nicely set out in boxes throughout the text. Each chapter ends with a summary entitled "The Least You Need to Know". Being well informed on health care choices is a requirement for living and taking care of one's family. You may be participating in a managed care plan without realizing it and be frustrated at procedures, which you do not understand. Do you know how your physician is paid? This book discusses payment arrangements. Do you know why some prescription drugs are favored over others by your HMO? This book explains what a "formulary" is and shows the difference between a "generic substitution", and a "therapeutic substitution". If you think "managed care" means only an HMO or PPO, you might be surprised to realize that even a traditional fee-for-service health insurance policy may include some aspects of managed care, such as prior approvals and second opinions. You may want to review your current health care coverage and make a new choice. This book helps you think through the various choices. If you lose your job, retire, have a child go off to college, are responsible for a parent with Medicare, then you will have to make choices on health care. I was impressed with the variety of special topics covered: managed care for seniors, managed care in rural areas, Medicaid managed care plans, emergency care, maternity care, chronic conditions, mental health and substance abuse treatment, medical records, and regulation and accreditation. Since I participate in an HMO, I thought I was reasonably well informed before reading this book. Nevertheless, I read this book diligently, instead of skimming it quickly, because it was genuinely interesting and informative.