Abstract
FLEXIBILITY will be the key to making health care reform work in and for rural America. That is the consensus of Clinton administration officials and experts on the "managed competition" model of reform that the President favors, who spoke at a "Health Care Reform in Rural Areas" conference in Little Rock, Ark. Paul Ellwood, MD, president of the Jackson Hole (Wyo) Group that devised the managed-competition model, says the term is a "misnomer in many if not all rural areas. Competition is not always feasible, and in fact can be very wasteful in many rural as well as urban areas." "Managed cooperation" is a more apt description of what is needed where a lack of access to health care is often more of a problem than health care cost, says Ellwood. In such areas, the Health Insurance Purchasing Cooperatives (HIPCs) envisioned under managed competition would "have to behave more like
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