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End Is Coming For Managed Care (Or Is It?)

Is managed care dying — or evolving? While few think managed care is going away, there's sharp disagreement on the form it will take in the future.

No doubt, MCOs are less restrictive than at one time. Paul Ginsburg, head of the Center for Studying Health System Change, told a Robert Wood Johnson Foundation conference on the future of managed care that health plans have accommodated physicians' and members' concerns — but perhaps at a long-term cost of inability to control utilization.

This has led to talk that plans eventually will decide the frustration isn't worth it and delegate cost-benefit trade-offs to consumers. But HMO executives present said that for all the talk of defined contribution, such a shift is unlikely soon.

Aetna's CEO, John Rowe, M.D., predicted that if the economy continues to soften, employers will migrate back to more tightly controlled plans.

At the same conference, University of California researchers presented evidence that MCOs provide the same quality of care as fee-for-service medicine. Their assessment was based on an analysis of more than 70 quality-of-care studies.

One hundred eighty degrees from these perspectives, a University of California–Berkeley economics professor predicted managed care's end in a Journal of the American Medical Association essay published the same week of the RWJ conference.

James Robinson, Ph.D., predicted that a "culture of consumerism" would replace employers, doctors, and insurers as the primary decision makers in health care. He labeled managed care an "experiment [that was] an economic success but a political failure," observing that managed care's failure to explain how it tries to "navigate tensions between limited resources and unlimited expectations" is its fundamental flaw.

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