MANAGED CARE includes a wide range of strategies and approaches difficult to monitor and evaluate and is poorly understood by the public. The variety of organizational options and their changing character also pose difficult problems for evaluators and regulators. The goal is to have sufficient understanding to encourage good practices and eliminate perverse ones, but the rush of legislators to micromanage developments may overshadow any such efforts.
There is increasing community mobilization in opposition to managed care practices reflected in a range of proposed legislation and referenda and new regulatory initiatives. In 1996 more than 1000 bills were introduced in state legislatures to control managed care practices and 56 laws were passed.1 Managed care also has been a significant area for congressional interest and presidential politics. Legislative initiatives range from establishing norms for length of inpatient stays to efforts to define acceptable transfer of risk to physicians, protect confidentiality,