Foundations for Medical Care

Abstract Foundations for Medical Care are management systems for health-services delivery, set up and run by physicians. "Claims-review" Foundations for Medical Care restrict themselves to peer-review activities consisting of reviewing payment claims that fall outside of established norms and are referred by fiscal intermediaries. "Comprehensive" Foundations for Medical Care, on the other hand, set minimum benefits packages and process all patient-services payment claims for peer review when appropriate. Significant cost reductions have been demonstrated by comprehensive Foundation peer review. Additional savings have been realized by adding hospital certification to the process. Some comprehensive Foundations have assumed a portion of the underwriting risk for a defined population and have provided comprehensive health services for a fixed annual sum on a capitation basis, thereby qualifying as Health Maintenance Organizations. Foundations for Medical Care have potential as a cost-effective management mechanism for the delivery of health services with a high level of quality assurance.