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The dramatic appearance of managed care organizations (MCOs) on the U.S. health scene has generated tremendous anxiety among health care providers and patients. These fears are based on the belief that managed care techniques pose greater risks of under treatment than do fee-for-service modes of payment. In addition, many physicians and patients resent the limits placed on clinical autonomy by the MCO model and the stresses that it places on the traditional physician-patient relationship. These misgivings have been exacerbated by the mostly negative response to MCOs in the media and academia. Legislatures have responded to these claims and public fears with a wave of regulatory initiatives. Some of these regulations are attempts to protect patients. Others, however, are motivated primarily by antipathy toward the concept of managed care itself. This essay is an attempt to develop a social ethic of regulation and argues that the sole reason that private enterprise may be justifiably limited is when it presents a risk of harm to others or society. While some regulation and proposed regulation of MCOs meet this standard, much legislation represents an unjustified attempt to limit or handicap otherwise legal behavior merely because a segment of the population and medical profession find it aesthetically unpleasing and oppose its approach to the delivery of health services. Key words: liberty, managed care, private enterprise, regulation

In the current political environment of health care, rehabilitation professionals must acquaint themselves with the language and strategies of the health care debate. Consequently, the purposes of this article are as follows: (1) to define managed care and examine its components; (2) to discuss the inherent contradictions between rehabilitation philosophy and health care reform; (3) to explore the components of public health care programs; and (4) to examine the merits of national health care for persons with disabilities. The article will not be inclusive about these issues but is intended to educate and facilitate further discussion., The magnitude of change in health care policy within the United States is parallel to the evolution of computer technology during the last decade. The changes have been swift, extensive, [...]

Health care reforms in the promoted by some democrats and Pres Clinton have failed to make it to a floor vote in Congress. The single payer reform proposed by a minority of Democrats in the House, although universal in appeal and devoid of insurance premiums, floundered for its sole emphasis on the 37 million uninsured Americans. The subsequent Clinton health plan failed in every way to address Americans' concerns about health care. Managed care, confused by combining aspects of several plans, bowed to the interests of powerful insurance companies.

Much of the debate surrounding health care reform is focussed on fee-for-service versus managed care health plans. A fee-for-service approach involves the freedom to choose a doctor while being covered by an insurance policy. Managed care grants less freedom of choice, but provides lower-cost health care by making the most of shared resources. In managed care plans, a general practitioner acts as a gatekeeper, limiting access to more expensive specialist care. The Clinton administration wants managed care, feeling that this approach will allow the market to behave most competitively, thereby lowering costs. Many physicians want to retain their professional autonomy, as well as their ability to set their own fees and are fighting for a fee-for-service reform plan.

The Clinton Administration favors managed competition as a way to reduce health care costs. Managed competition would create Health Insurance Purchasing Cooperatives (HIPCs) that would certify managed care plans and offer their benefits packages to employees who are not covered by an employer's plan. However, employees might have to change doctors if they change jobs or if the HIPC drops a managed care plan. This would undermine the continuity of care that is so crucial to the doctor-patient relationship. Since managed care plans would have to compete with each other, consumers could be faced with false or misleading advertising. Unrealistic expectations on the patient's part could cause a conflict between patient and doctor. It may be possible to structure health care reform in such a way that it does not damage the doctor-patient relationship.

This article presents the results of the comparative research project, 'Managed Care in Latin America: Its Role in Health System Reform.' Conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States, the study focused on the exportation of managed care, especially from the United States, and its adoption in Latin American countries. Our research methods included qualitative and quantitative techniques. The adoption of managed care reflects the process of transnationalization in the health sector. Our findings demonstrate the entrance of the main multinational corporations of finance capital into the private sector of insurance and health services, and these corporations' intention to assume administrative responsibilities for state institutions and to secure access to medical social security funds. International lending agencies, especially the World Bank, support the corporatization and privatization of health care services, as a condition of further loans to Latin American countries. We conclude that this process of change, which involves the gradual adoption of managed care as an officially favored policy, reflects ideologically based discourses that accept the inexorable nature of managed care reforms. Keywords: Latin America; Health policy; Managed care programs; Health maintenance organizations; Privatization; Public health; Economics; Medical