This book examines the evolving health care delivery systems and the role of nursing within the rural context. Divided into three parts including perspectives from experts in Australia and Canada, the book covers the foundations of rural nursing, special populations, and future perspectives. Students of nursing will find special features in each chapter such as a list of objectives, key terms, points to remember, suggested research activities, and discussion questions.

The Meaning of Managed Care for Rural America

The meaning of managed care for rural America

Key Terms

  • Capitation
  • Comprehensive span of services
  • Fee for service
  • Managed care
  • Managed care organization (MCO)
  • Prepayment
  • Risk sharing
  • Third-party payer
  • Marginalizing providers
  • Gatekeeping
  • Critical access hospital (CAH)
  • Covered lives
  • Utilization review
  • Quality assurance assessment/measures

Objectives

After reading this chapter, you will be able to

  • Identify factors that can affect penetration of managed care into rural market areas.
  • Compare and contrast characteristics of rural counties included in managed care organization services areas with those that are not in managed care organization service areas.
  • Discuss the roles of nurses in rural managed health care organizations.

Essential Points to Remember

  • Managed care is expanding in rural areas, but enrollment rates still are relatively low. ...
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