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February 19, 1997, Vol 277, No. 7 >
ARTICLE | February 19, 1997

Managed Care: Title and subTitle BreakA Product of Market Dynamics FREE

David F. Drake, PhD
[+] Author Affiliations

Dr Drake is the retired secretary-treasurer of the American Hospital Association, Chicago, Ill, and is writing Breaking the Health Reform Gridlock, on which this article is based.

Reprints: David F. Drake, PhD, PO Box 691, Beverly Shores, IN 46301.


JAMA. 1997;277(7):560-563. doi:10.1001/jama.1997.03540310058035
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References

The development of managed care is described as an unexpected product of competition between public and private purchasers of health care. Managed care is a series of purchasing techniques that employers have applied to reduce the cost of their employees' health benefits. Its most significant use has been as a device for bargaining with individual health care providers by encouraging or requiring employees to purchase health care services from a select set of providers. Selective contracting has broken a 40-year-old barrier to price competition among health care providers, who have responded to this negotiating tactic by forming or joining larger organizational units to strengthen their bargaining power. Although the so-called managed care revolution has reduced the rate of increase in health care costs by creating a more competitive price environment, it is simply a start toward a more effective health care market. It is very much a work in progress that will affect and be affected by both political and market changes occurring over the remainder of this century.

REFERENCES

1 +
Drake DF. Reforming the Health Care Market: An Interpretive Economic History . Washington, DC: Georgetown University Press; 1994;.
2 +
Levit KR, Lazenby H, Waldo DR, Davidoff LM.  National health expenditures, 1984 . Health Care Financ Rev . (Fall) 1985;;7:1-35.
3 +
Cowan CA, McDonnell PA.  Buiness, households, and governments: health spending, 1991 . Health Care Financ Rev . (Spring) 1993;;14:227-248.
4 +
US Dept of Health and Human Services. Health Care Finance Review, Medicare and Medicaid Statistical Supplement, 1995 . Baltimore, Md: US Dept of Health and Human Services; 1995;.
5 +
American Hospital Association. National Hospital Panel Survey. Chicago, Ill: American Hospital Association; various years.
6 +
Levit KR, Lazenby HC, Sivarajan L, et al.  National health expenditures, 1994 . Health Care Financ Rev . (Fall) 1996;;17:205-242.
7 +
Robinson JC, Luft HS.  Competition and the cost of hospital care, 1972 to 1982 . JAMA . 1987;;257:3241-3245.
8 +
Melnick GA, Zwanziger J.  State health care expenditures under competition and regulation, 1980-1991 . Am J Public Health . 1995;;85:1391-1395.
9 +
Melnick GA, Zwanziger J, Bamezai A, Pattison R.  The effect of market structure and bargaining position on hospital prices . J Health Econ . 1992;;11:217-233.
10 +
Melnick GA, Zwanziger J, Bradley T.  Competition and cost containment in California: 1980-1987 . Health Aff (Millwood) . (Summer) 1989;;8:129-136.
11 +
Zwanziger J, Melnick GA, Bamezai A.  Costs and price competition in California hospitals, 1980-1992 . Health Aff (Millwood) . (Fall) 1994;;13:118-126.
12 +
Pallarito K.  Managed care making Medicare look generous . Mod Healthcare . (November 20) ,1995;;25:56.
13 +
Burkins G.  Health costs' growth rate slows further . Wall Street Journal . (August 1) , 1996;:A16.
14 +
McMillian A.  Trends in Medicare health manitenance organization enrollment: 1986-93 . Health Care Financ Rev . (Fall) 1993;;15:135-146.
15 +
Hellinger FJ.  Selection bias in HMOs and PPOs: a review of the evidence . Inquiry . (Summer) 1995;;32:135-142.
16 +
Mechanic D, Schlesinger M.  The impact of managed care on patients' trust in medical care and their physicians . JAMA . 1996;;275:1693-1697.
17 +
Feldman R, Wholey D, Christianson J.  Economic and organizational determinants of HMO mergers and failures . Inquiry . (Summer) 1996;;33:118-132.
18 +
Luft HS, Bunker JP, Enthoven AC.  Should operations be regionalized? the empirical relation between surgical volume and mortality . N Engl J Med . 1979;;301:1364-1369.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Drake DF. Reforming the Health Care Market: An Interpretive Economic History . Washington, DC: Georgetown University Press; 1994;.
2 +
Levit KR, Lazenby H, Waldo DR, Davidoff LM.  National health expenditures, 1984 . Health Care Financ Rev . (Fall) 1985;;7:1-35.
3 +
Cowan CA, McDonnell PA.  Buiness, households, and governments: health spending, 1991 . Health Care Financ Rev . (Spring) 1993;;14:227-248.
4 +
US Dept of Health and Human Services. Health Care Finance Review, Medicare and Medicaid Statistical Supplement, 1995 . Baltimore, Md: US Dept of Health and Human Services; 1995;.
5 +
American Hospital Association. National Hospital Panel Survey. Chicago, Ill: American Hospital Association; various years.
6 +
Levit KR, Lazenby HC, Sivarajan L, et al.  National health expenditures, 1994 . Health Care Financ Rev . (Fall) 1996;;17:205-242.
7 +
Robinson JC, Luft HS.  Competition and the cost of hospital care, 1972 to 1982 . JAMA . 1987;;257:3241-3245.
8 +
Melnick GA, Zwanziger J.  State health care expenditures under competition and regulation, 1980-1991 . Am J Public Health . 1995;;85:1391-1395.
9 +
Melnick GA, Zwanziger J, Bamezai A, Pattison R.  The effect of market structure and bargaining position on hospital prices . J Health Econ . 1992;;11:217-233.
10 +
Melnick GA, Zwanziger J, Bradley T.  Competition and cost containment in California: 1980-1987 . Health Aff (Millwood) . (Summer) 1989;;8:129-136.
11 +
Zwanziger J, Melnick GA, Bamezai A.  Costs and price competition in California hospitals, 1980-1992 . Health Aff (Millwood) . (Fall) 1994;;13:118-126.
12 +
Pallarito K.  Managed care making Medicare look generous . Mod Healthcare . (November 20) ,1995;;25:56.
13 +
Burkins G.  Health costs' growth rate slows further . Wall Street Journal . (August 1) , 1996;:A16.
14 +
McMillian A.  Trends in Medicare health manitenance organization enrollment: 1986-93 . Health Care Financ Rev . (Fall) 1993;;15:135-146.
15 +
Hellinger FJ.  Selection bias in HMOs and PPOs: a review of the evidence . Inquiry . (Summer) 1995;;32:135-142.
16 +
Mechanic D, Schlesinger M.  The impact of managed care on patients' trust in medical care and their physicians . JAMA . 1996;;275:1693-1697.
17 +
Feldman R, Wholey D, Christianson J.  Economic and organizational determinants of HMO mergers and failures . Inquiry . (Summer) 1996;;33:118-132.
18 +
Luft HS, Bunker JP, Enthoven AC.  Should operations be regionalized? the empirical relation between surgical volume and mortality . N Engl J Med . 1979;;301:1364-1369.

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