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Is Managed Health Care Dead?

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A few years ago, some opined that managed care was either dead or nearly dead. Years later, managed care seems stronger than ever, or is it?

1. What is managed care and where did it come from?

2. Why did some speak of the death of managed care?

3. What is the current state of managed care in the U.S. health care system?

Please give references so I can conduct more research!

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Solution Summary

Managed Health Care is debated on a number of dimensions e.g. nature and origin of managed care, the notion of the death of managed care, and the current state of managed care in the U.S. health care system. Supplemented with one article concerning the death of managed care. References are also provided for further research.

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Hi,

Interesting questions! Let's take a closer look. I also attached one supporting article.

RESPONSE:

1. What is managed care and where did it come from?

Managed care evolved overtime as a way to control the use of health care services, and have been around for a long time. Prepaid health plans go back as far as 1869, when the sisters charged $.25 a week or $13.00 a year for care which assured care from the St. Mary's Informatory in Galveston, Texas. (see extension historical evolution from an on-line excerpt from a bookat http://books.google.ca/books?hl=en&id=ZaI3tIorI9UC&dq=WHAT+IS+MANAGED+CARE&printsec=frontcover&source=web&ots=V092wMwfHk&sig=NmXOstWddgbB9dEF_uB1-L_EMBs&sa=X&oi=book_result&resnum=3&ct=result#PPA11,M1, p. 11.

One definition of Managed Care is as follows;

" Systems and techniques used to control the use of health care services. Includes a review of medical necessity, incentives to use certain providers, and case management. The body of clinical, financial and organizational activities designed to ensure the provision of appropriate health care services in a cost-efficient manner. Managed care techniques are most often practiced by organizations and professionals that assume risk for a defined population (e.g., health maintenance organizations) but this is not always the case. Managed care is a broad term and encompasses many different types of organizations, payment mechanisms, review mechanisms and collaborations. Managed care is sometimes used as a general term for the activity of organizing doctors, hospitals, and other providers into groups in order to enhance the quality and cost-effectiveness of health care. Managed Care Organizations (MCO) include HMO, PPO, POS, EPO, PHO, IDS, AHP, IPA, etc. Usually when one speaks of a managed care organization, one is speaking of the entity that manages risk, contracts with providers, is paid by employers or patient groups, or handles claims processing. Managed care has effectively formed a "go-between", brokerage or 3rd party arrangement by existing as the gatekeeper between payers and providers and patients. The term managed care is often misunderstood, ...

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