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date: 20 November 2019

Abstract and Keywords

This chapter deals with approaches for managing healthcare and costs for a defined, insured population in the United States. Drawing on case studies from Kaiser Permanente, it stresses the importance of providing affordable and quality healthcare to a defined population. It first outlines some of the business, cultural, and legal challenges to replicating important elements of the Kaiser Permanente model before turning to a discussion of three complementary approaches to managing care and costs in a defined population. Within each approach, those who pay for care (employers and insurers) and those who provide it (doctors and hospitals) rely on a number of “tools” ranging from social contract to the design of benefits and payment arrangements for healthcare providers. The chapter concludes by discussing policy choices that could affect the ability of healthcare systems to manage care and costs.

Keywords: insured population, Kaiser Permanente, healthcare, social contract, healthcare costs, employers, insurers, doctors, hospitals, payment

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