The global outlook series on Managed Health Care Services provides anecdotes,
market briefs, and concise summaries of research findings. The report analyzes
the growth drivers and market challenges, and reviews the noteworthy strategic
corporate activity of the recent past. The report also discusses various types
of managed care organizations and programs. A detailed review of the United
States market is provided in the report, along with brief discussions on
European, Hong Kong, and Nigerian markets. Also included is an indexed,
easy-to-refer, fact-finder directory listing the addresses, and contact
details of 310 companies worldwide.
Table of Contents
1. INDUSTRY OVERVIEW 1
Market Overview 1
Quick Facts 1
Recession Hits Managed Care 1
Factors Impacting Managed Care Market 1
Health Care Expenditure in Developed Nations 2
Health Care System in Developing Countries 2
Affordability and Equitable Access Ensures Balanced Health Care 2
Government Initiatives 3
Sustainability Helps to Strike a Balance 3
2. PRODUCT OVERVIEW 3
Managed Health Care - A Conceptual Definition 3
Benefits 4
Managed Health Care - Historical Perspective 4
Managed Care Organizations (MCOs) 5
Managed Care Services for Healthcare Providers 5
Cost Reducing Managed Care Techniques 5
Managed Care Approaches 5
3. TYPES OF MANAGED CARE 6
Types of Network-Based Managed Care Programs 6
Health Maintenance Organizations (HMOs) - An Introduction 6
Features of HMOs 6
History of Health Maintenance Organizations 6
Types of HMOs 7
Primary Care Physician (PCP) 7
Staff/Group Model HMOs 7
Fee for Service Plan (FFS) 7
Independent or Individual Practice Association (IPA) 7
Preferred Provider Organizations (PPO) 7
Point-Of-Service Plans (POS) 8
Other Managed Care Programs 8
Physician-Hospital Organizations (PHOs) 8
Different PHO Structures 8
Prescription Drug Programs 9
Dental Specialty Programs 9
Managed Care Under Indemnity Insurance Plans 9
Stop Loss Arrangements 9
Mixed or Network Model HMO 9
Exclusive Provider Organization (EPO) 9
Consumer Driven Health Plans (CDHPs) 9
4. MERGERS & ACQUISITIONS 10
5. OTHER STRATEGIC CORPORATE DEVELOPMENTS 19
A REGIONAL MARKET PERSPECTIVE
1. THE UNITED STATES 22
Managed Care Market - An Outlook 22
US Health Care Industry - An Overview 22
Table 1: Health Care Expenditure in the US - Annual Figures in US$
Trillion for Year 2008 through 2012 23
Table 2: Health Care Market in the US (2008): Percentage Share Breakdown
of Expenditure by Health Care Segment 23
Health Care Costs Continue to Escalate 24
Challenges Faced by the US Healthcare Industry 24
Medical Costs - Future Growth 24
Table 3: Managed Care Medical Costs in the US: Percentage Growth of by
Category (2008) 24
Table 4: Health Care Market in the US (2008): Percentage Breakdown of
Medical Costs by Category 25
A Peek Into Noteworthy Trends & Issues 25
Economic Recession and Managed Care Market 25
Stimulus Bill Offers a Promise or a Threat? 25
Managed Care Medicaid Enrollments Improve 26
Table 5: Managed Care Market in the US (2008): Percentage Breakdown of
Enrollments by Plan Type 26
Table 6: Number of Managed Care Enrollments in the US by State (2008)
(In Million) 27
Table 7: Managed Care Market in the US (2008): Leading PPO Networks
Ranked by Number of Lives with Network Access (In Million) (In Million) 28
Rising Rate of Unemployment Impacts Managed Care 28
Medicaid Managed Care - Major Care Delivery System 28
Commercial Enrollment Remains Challenging 29
Table 8: Percentage of Managed Care Providers Offering Health Benefits
in the US (2005-2008) 29
Table 9: Managed Care Market in the US (2009E): Number of Enrollments
by Health Plan (In Million) 30
Rising Costs of Health Care for Employers 30
Employers Strategize to Reduce Operating Costs 30
Insurance Companies Turn to Managed Care 31
Competition 31
Table 10: Managed Care Market in the US (2008): Percentage Share
Breakdown of Total Enrollments by Provider 31
Large Health Plans Dominate Managed Care Market 32
Table 11: Managed Care Market in the US by Number of MCOs and Number
of Health Plan Members (2008) 32
Table 12: Managed Care Market in the US (2008): Number of Health Plan
Members by Health Plan 33
HMO Market - An Overview 33
Competitive Landscape 33
Table 13: Managed Care Market in the US (2008): Number of HMO
Enrollments by Leading Health Plans (In Million) 34
Disease Management Programs Propel HMOs Growth 34
Table 14: Percentage of HMOs Offering Disease Management Programs in
the US by Disease Type 35
Reinsurance Market Overview 35
Provider Excess Market 35
Dental Managed Care Market 36
Competitive Scenario 36
2. EUROPE 36
Healthcare Market - An Overview 36
Managed Care Market 37
Market Features 37
Corporate Layoffs Deter Managed Care Growth 37
3. HONG KONG 37
Market Overview 37
Table 15: Managed Care Market in Hong Kong (2008): Percentage Share
Breakdown of Compensation to Physicians (Operating Individually) by Type 38
Table 16: Managed Care Market in Hong Kong (2008): Percentage Share
Breakdown of Compensation to Physicians (Working in Group) by Type 38
