Regulating Managed Care: Theory, Practice, and Future Options

Regulating Managed Care: Theory, Practice, and Future Options

Regulating Managed Care: Theory, Practice, and Future Options

Regulating Managed Care: Theory, Practice, and Future Options


What should be government's role in a market-oriented health care system?

What's the appropriate amount of regulation?

Who should regulate-states, federal government, or market forces?

What role do the courts play in this regulation?

Are there existing models that might guide leaders in designing an effective regulatory structure?

Welcome to the great managed care debate. In Regulating Managed Care, twenty-six of the nation's leading health policy experts give health care administrators, clinicians, and policy makers insight into the issues behind this critical exchange and provide leaders with a road map to assess the policy options available to protect the quality of our health care delivery system.

"This collection of papers, from an extraordinary group of authors, makes a valuable contribution to the ongoing policy debate and will be of interest to anyone concerned with the future of our health care system."---Charles A. Sanders, retired chairman and CEO Glaxo Inc. and former general director, Massachusetts General Hospital


In our pluralistic society, the trends in social policy often swing like a pendulum. They overcome inertia and gain momentum in one direction only to swing back the other way, ultimately settling somewhere near the gravitational center. In issues such as personal health, which touches the lives of all of us, interest in that center is likely to be strong. In 1994, the country rejected a large government role in health care and began to pursue a market-based system. But five years later, after sampling the benefits and detriments of market-based medicine, the pendulum has begun to swing the other way. Legislation to regulate managed care has proliferated at both the state and federal levels of government and is at the top of the congressional agenda as we advance through the last year of the millennium. Policymakers, clinicians, and consumers are struggling to find the right balance between competition and regulation that will result in a high-quality and compassionate health care system, accessible and affordable to all Americans. This volume, with contributions by many of the nation's leading experts in health care policy, provides a comprehensive examination of the issues from a broad range of political perspectives.

In the late 1980s and early 1990s, annual increases in health care inflation were in the double digits, and employers and consumers found health insurance increasingly unaffordable. In response, the Clinton administration attempted to legislate comprehensive health care reform. But the country rejected the government's large role in that plan, and instead pursued marketoriented reforms based on a system of competitive managed care.

Enrollment in managed care organizations grew rapidly during the 1980s, and many analysts have expounded on the potential virtues of managed care: to make the delivery of health care . . .

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