Competitive Managed Care

The Emerging U.S. Health Care System

The first comprehensive assessment of the new managed care and its potential for addressing the health delivery problems facing the nation.
--Stephen M. Shortell, A. C. Buehler, Distinguished Professor of Health Services Management and professor of organization behavior, J. L. Kellogg Graduate School of Management, Northwestern University

A distinguished group of sixteen health care experts identify and assess the challenges and opportunities raised by the U.S.'s emerging competitive health care system. This timely book looks at the managed forms of care that are thriving in today's competitive bottom line
environment. A thoughtful commentary on the major trAnds in health care, this book provides a much needed resource for health care providers and government policymakers. UNDERSTANDING COMPETITIVE MANAGED CARE.

The Emerging Competitive Managed Care Marketplace (J. Wilkerson, et al.).

Perspectives and Evidence on Efficiency in Managed Care Organizations (H. Luft).

PRIVATE SECTOR INITIATIVES AND RESPONSES.

The Role of Purchasing Groups (L.Bergthold & L. Solomon).

Exercising Purchasing Power for Prevention (H. Schauffler & T. Rodriguez).

The Challenge of Measuring and Monitoring Quality (A. Bindman).

The Future of the Health Professions Under Managed Care (E. O'Neil & L. Finnocchio).

Inside the System: The Patient-Physician Relationship in the Era of Managed Care (H. Waitzkin & J. Fishman).

PUBLIC SECTOR INITIATIVES AND RESPONSES.

Ensuring Competition in the Market for HMO Services (R. Given).

State-Sponsored Health Insurance Purchasing Cooperatives: California's "HIPC" (T. Buchmueller).

Managing the Managed Care Revolution: States and the New Medicaid (M. Sparer).

The Challenges of Implementing Market-Based Reform for Public Clients (K. Devers).

Messing with Medicare: Markets and Politics in the 104th Congress (J. Wilkerson).

Lessons for the United States: Britain's Experience with Managed Competition (D. Light).

Conclusion: The Potential and Limits of Competitive Managed Care. "Wilkerson, Devers, and Given have developed a timely, well-integrated collection of articles on competitive managed care. This is a very thoughtful treatment of today's health care issues and merits our reading and reflective consideration." --Richard M. Burton, D.B.A., Professor Fuqua School of Business, Duke University, Inquiry

"The first comprehensive assessment of the new managed care and its potential for addressing the health delivery problems facing the nation. Important reading for policymakers, policy analysts, researchers, and students alike." --Stephen M. Shortell, A. C. Buehler, Distinguished Professor of Health Services Management and professor of organization behavior, J. L. Kellogg Graduate School of Management, Northwestern University

?Wilkerson, Devers, and Given have produced a `must-read' text for physician leaders, health managers, and health policymakers and students interested in comparing economic theory and principles with what is actually happening in the competitive managed care marketplace. I found every chapter fascinating and very useful.? --John C. Lewin, executive vice president/CEO, California Medical Association

?A balanced and readable text that unravels the complexity of our government-regulated health care marketplace. By examining the perspectives of important stakeholders through both theory and case study, the well-respected editors and authors explain clearly why neither extreme alone (regulation nor free market) would work in the U.S.? --Alan L. Hillman, associate dean and associate professor, School of Medicine, University of Pennsylvania, Philadelphia JOHN D. WILKERSON Kelly J. Devers, and Ruth S. Given collaborated on this book while they were Robert Wood Johnson Scholars in the Health Policy Research Program at the University of California, Berkeley. John D. Wilkerson is assistant professor of political science at the University of Washington, Seattle. Kelly J. Devers is an expert appointee at the Agency for Health Care Policy and Research, Center for Organization and Delivery. Ruth S. Given is director of the Department of Health Care Policy at the California Medical Association. As the U.S. health care system continues to shift to an environment in which managed care organizations are intensely price competitive, what are the consequences for private and public purchasers, health care providers, and the consumer? In this timely book, a distinguished group of sixteen health care experts, including physicians, political scientists, sociologists, and economists, identify and assess the challenges and opportunities raised by America's emerging competitive health care system. As the authors explain, health care markets have characteristics that do not conform to competitive conditions. Freely operating health care markets will not produce and allocate health care services efficiently, and they will not provide the distribution of services that Americans have historically favored.By offering thoughtful commentary on the major trAnds in health care, the book provides a much needed resource for health care providers, managers, and administrators as well as government policymakers. This compelling book

• Examines the evidence for greater efficiency of managed forms of care.
• Describes the role that employers and purchasing cooperatives are playing in promoting competition among health plans to lower premium costs.
• Assesses the implications of these changes for practitioners and educators in different health professions, including nursing, medicine, allied health, and public health.
• Investigates how increased price competition among managed care organizations is affecting the relationship between providers and their patients.
• Identifies the appropriate roles and responsibilities of governments in the emerging health care market.

America's health care environment is rapidly changing from a system in which health care providers compete by focusing on service and amenities to a system in which providers compete primarily on the basis of price. Managed forms of care that integrate the financing and delivery of health care servic In this timely book, a distinguished group of sixteen health care experts, including physicians, political scientists, sociologists, and economists, identify and assess the challenges and opportunities raised by America's emerging competitive health care system. As the authors explain, health care markets have characteristics that do not conform to competitive conditions. Freely operating health care markets will not produce and allocate health care services efficiently, and they will not provide the distribution of services that Americans have historically favored.