An historical perspective on the roots of managed care

Current Opinion in Pediatrics

Volumn 8, Issue 2, 1996, Pages 159-163

  Shapiro, Sam ^a  

^a JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE FINANCING; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; PRIORITY JOURNAL; REVIEW; UNITED STATES;

EID: 0029996083     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/00008480-199604000-00014     Document Type: Review

References (18)

1. Freeborn DK, Pope CR: Promise & Performance in Managed Care: The Prepaid Group Practice Model. Baltimore: The Johns Hopkins University Press; 1994. Many questions raised about HMOs are considered, and the authors interpret the policy implications of what they have found. Explored are why people select alternative plans and why they stay or move from them; personal and system factors that influence utilization of services; satisfaction with HMOs and fee-for-service sources of care; and physicians' attitudes toward HMOs.
2. MacColl WA: Group Practice and Prepayment of Medical Care. Washington, DC: Public Affairs Press; 1966.
3. Committee on the Costs of Medical Care: Medical Care for the American People. Chicago: University of Chicago Press; 1932.
4. Luft HS: Health Maintenance Organizations: Dimensions of Performance New York: John Wiley & Sons; 1981.
5. McNeil R Jr, Schlenker RE: HMOS, competition, and Government. Milbank Memorial Fund Q Health Soc 1975, 53:195-224.
6. Commission on Medical Care Plans: Report of the commission: findings, conclusions and recommendations. JAMA 1959, 169:1-96.
7. Harrington DC: Health maintenance organizations: a prototype. California-San Joaquin Foundation for Medical Care. Hospitals 1971, 45:67-68.
8. Ellwood PM Jr: Health maintenance organizations: concept and strategy. Hospitals 1971, 45:53-55.
9. Nixon RM: Health Message from the President of the United States Relative to Building a National Health Strategy. Washington, DC: US Government Printing Office; 1971.
10. Dorsey JL: The Health Maintenance Organization Act of 1973 (P.L. 93-222) and prepaid group practice plans. Med Care 1975, 13:1-8.
11. Seubold FH: HMO's: the view from the program. Public Health Rep 1975, 90:99-103.
12. Cunningham F, Shapiro S, Horn S: Factors influencing progress towards viability of federally funded HMOs. Group Health J 1983, 4:12-26.
13. Group Health Association of America: Patterns in HMO Enrollment. Washington, DC: Group Health Association of America; 1995. This report demonstrates the rapid growth of HMO enrollment over the past 20 years, from 6 million to 56 million. About 30% of the HMO plans and half of all members are in either staff, group, or network plans; the remainder are in IPAs.
14. Shapiro S: Research in prepaid group practice programs. Am J Public Health 1964, 54:2040-2050.
15. Greenlick MR, Freeborn DK, Colombo TJ, Prussin JA, Saward EW: Comparing the use of medical care services by a medically indigent and a general membership population in a comprehensive prepaid group practice program. Med Care 1972, 10:187-200.
16. Greenlick MR, Freeborn DK, Pope CR: Health Care Research in an HMO: Two Decades of Discovery. Baltimore: Johns Hopkins University Press; 1988.
17. Hughes DC, Newacheck PW, Stoddard JJ, Halfon N: Medicaid managed care: can it work for children? Pediatrics 1995, 95:591-594. Little information is available on Medicaid managed care, but what there is shows mixed results in terms of improved access to primary and preventive health services. The emphasis on cost savings by Medicaid managed care has contributed to the lack of meeting the promise of this type of care. In addition, the potential for cost savings is low among children enrolled in Medicaid. A major point is made that Medicaid programs need to take into account the special needs of low-income children.
18. Berman S, Bogdan JC, Buchanan GA, Curran JS, Garson A, Gross RD, Halfon N, Lewak N, Nelson R, Committee on Child Health Financing of the American Academy of Pediatrics: Guiding principles for managed care arrangements for the health care of infants, children, adolescents, and young adults. Pediatrics 1995, 95:613-615. The committee report notes that it is important to monitor the impact of cost-containment measures on the quality and outcome of medical services for children. States should implement regulatory oversight to ensure the quality and financial viability of participating managed care plans in programs where the state has mandated enrollment in Medicaid managed care programs. Guiding principles for managed care are given, and the American Academy of Pediatrics seeks to collaborate in adopting these principles to assure access to high-quality pediatric services.