The who, what, and how of managed care.

Abstract

Since the early 1970s, policy makers and researchers alike have been eagerly watching and evaluating the growth of so-called managed care plans. Many expected prepaid group practice plans (PGPs), then individual practice associations (IPAs), then preferred provider organizations (PPOs), and a host of other insurance arrangements under the managed care label, to result in a more efficient allocation of resources. Others predicted that these changes from the traditional indemnity insurance plans would lead to the denial of needed care and a reduction in the freedom of choice, both for providers and patients. It is a major problem to determine whether either change has taken place because most policy makers and researchers have been less than clear about who or what these plans are supposedly managing, much less how they are managing it. What is this phenomenon called managed care that has elicited so much hope and fear? The confusion exists in part because researchers have used managed care as “the shorthand label for a wide variety of health plans” (Prologue 1999) with “little consensus regarding labels and few accepted criteria for categorization” (Weiner and de Lissovoy 1993: 75). Some might argue that the label is unimportant. However, without knowing what the term managed careis encompassing, how do we know what it is that physicians are presumably revolting against? (see, e.g., Rosenberg 1998; and Ginsburg 1997). Is it “the entire range of utilization control tools that are applied to manage the practices of physicians and others, regardless of the setting in which they practice?” (Weiner and de Lissovoy 1993: