Availability of beds in rural areas may be a factor. In addition, the attitudes of older persons in rural areas may contribute to a positive regard for nursing facilities. The National Committee for Quality Assurance . The quality of care provided by managed care organizations is a topic of concern for health providers, payers, and consumers. Previously, health care quality has been measured by professional judgment, often subjectively.
More scrutiny is now the norm as health plans compete for dollars and customers.
Many plans believe that a quality review from an independent review body can help them increase their share of the market. This organization was formed in 1979 through a joint effort of the American Managed Care and Review Association and the Group Health Association of America. NCQA became independent in 1990 and has as its main source of revenue the fees charged for each accreditation survey. Robinson, James C. Decline in Hospital Utilization and Cost Inflation Under Managed Care in California . A growing number of medical and surgical procedures are being shifted from acute inpatient facilities to outpatient, subacute, and home care settings.