NEJM Examines Trends and Future of Managed Care
Managed care "now dominates health care in the United States," but its future is "uncertain," R. Adams Dudley and Harold Luft of the University of California-San Francisco write in the sixth installment of the New England Journal of Medicine's Health Policy 2001 series. In an article examining the evolution and future of managed care, the authors state that despite recent complaints about managed care organizations placing cost concerns ahead of patient care and superseding physicians in determining the proper level of treatment, "medical groups seem to be assuming a stronger stance in their negotiations with MCOs, and employers, as well as federal and state governments, are becoming more sophisticated in the use of measures to promote and reward high-quality care." In addition, many insurers have reacted to complaints by "eliminating administrative practices that restrict patients' choices" and by emphasizing preventive treatment and "other measures that increase the coordination of care." While managed care has often led to a "fragment[ation]" of care, the authors state that care coordination could be restored by an "appropriately designed system of prepayment -- with rates that are high enough to cover all appropriate care and the costs of treating catastrophic illness, as well as incentives for providers to plan for the future." However, the authors conclude, "medical costs are on the rise again, and if the primary focus of the policy debate returns to financial considerations, efforts to improve the quality of care may be postponed" (Dudley/Luft, New England Journal of Medicine, 4/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.