Casting recent changes in health care as the product of a mass movement, and comparing this movement to others like it, this brief history recounts the sudden rise and long decline of managed care. Chapters discuss its origins, expansion, supporters, financiers, the resistance it faced, the bind it created, early tremors, its collapse, and its current state. Smith's credentials are not noted. Annotation copyrighted by Book News, Inc., Portland, OR.

Once touted as the answer to defects in fee-for-service health care insurance, managed care has seen its fortunes rise and fall over the past decade. Initially, managed care techniques became widespread, and they slowed the growth in health care costs. Indeed, premiums for health care insurance went from double-digit increases in the late 1980s to a less than two percent increase in 1996. More recently, however, public dissatisfaction with managed care has led insurers to jettison key cost-containment strategies of managed care, including closed panels of doctors, primary-care gatekeeping and pre-admission authorization. As insurers abandoned these hallmarks of managed care, health care costs have resumed their rapid growth. Scholars have attributed the fall of managed care to a number of factors, including imperfections in the market for health care insurance, the use by some managed care plans of egregious strategies for cutting costs, and a lack of consumer choice or voice in the operation of managed care. This article offers a different explanation for the rise and fall of managed care. Managed care has failed not because of market imperfections, a bad design, or because its design was poorly executed. Rather, the United States's experience with managed care illustrates what happens when society tries to ration health care resources, regardless of the mechanism used for rationing. In this view, problems with the health care market or the design and implementation of managed care might have affected how quickly managed care failed, but they did not affect whether managed care would fail. As a method for making the "tragic choices" involved in health care rationing, managed care's failure was inevitable, as predicted by the analysis of Guido Calabresi and Phillip Bobbitt in their book, Tragic Choices. Calabresi and Bobbitt explain that the difficult life-and-death choices entailed in rationing can only be made by hiding them from public scrutiny. Managed care provided a method for disguising rationing. However, when the hidden "tragic choices" were exposed, the method for making those choices became discredited, and the public had demanded a new method for allocating health care.

"Drawing upon a wealth of research, Coombs compares HMOs throughout the nation with the one in Marshfield, which came as close as any HMO to realizing the ideal of early advocates. This book is a resource for specialists in the fields of health policy research and analysis, health care management, health law and politics, public health, and social and organizational history of medicine. It will also appeal to many readers who are disturbed by the current stae of America's health care system and are curious about its future."--BOOK JACKET.

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

The American health care industry has undergone such dizzying transformations since the 1960s that many patients have lost confidence in a system they find too impersonal and ineffectual. Is their distrust justified and can confidence be restored? David Dranove, a leading health care economist, tackles these and other key questions in the first major economic and historical investigation of the field. Focusing on the doctor-patient relationship, he begins with the era of the independently practicing physician--epitomized by Marcus Welby, the beloved father figure/doctor in the 1960s television show of the same name--who disappeared with the growth of managed care. Dranove guides consumers in understanding the rapid developments of the health care industry and offers timely policy recommendations for reforming managed care as well as advice for patients making health care decisions. The book covers everything from start-up troubles with the first managed care organizations to attempts at government regulation to the mergers and quality control issues facing MCOs today. It also reflects on how difficult it is for patients to shop for medical care. Up until the 1970s, patients looked to autonomous physicians for recommendations on procedures and hospitals--a process that relied more on the patient's trust of the physician than on facts, and resulted in skyrocketing medical costs. Newly emerging MCOs have tried to solve the shopping problem by tracking the performance of care providers while obtaining discounts for their clients. Many observers accuse MCOs of caring more about cost than quality, and argue for government regulation. Dranove, however, believes that market forces can eventually achieve quality care and cost control. But first, MCOs must improve their ways of measuring provider performance, medical records must be made more complete and accessible (a task that need not compromise patient confidentiality), and patients must be willing to seek and act on information about the best care available. Dranove argues that patients can regain confidence in the medical system, and even come to trust MCOs, but they will need to rely on both their individual doctors and their own consumer awareness.