A proposal for managed care payment options for patients with chronic conditions

Abstract

This paper proposes an episode of care payment system for patients with chronicillnesses, extending earlier published work on this model of ambulatory care (Duckett& Jackson 1993). The payment system relies on annual voluntary enrolment andsome marginal broadening of Medicare coverage in exchange for patients? willingnessto participate in an ambulatory managed care arrangement. In the context ofAustralian health ministers? enthusiasm for managed care, the proposal embodiesan intermediate policy approach which supports greater health care efficiency whileminimising the prospect for reductions in patient autonomy or serious distortionsin patterns of care. The policy is not designed to be applied population-wide, butto address the issues involved with a resource-intensive patient group, those requiringongoing management of chronic conditions.