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Managed care refers to processes or techniques used by, or on behalf of, purchasers of health care to control or influence the quality, accessibility, utilization, and costs of health care. Managed care emphasizes cost containment, performance assessment, measurable outcomes and subjects the treatment actions of health care providers to external review. Treatment decisions are evaluated in light of measurable client level outcomes; consequently managed care has resulted in a greater emphasis on accountability. There is also an increased emphasis on standardization of clinical practices and reliance upon evidence based medicine. Because treatment is reimbursed when there is a valid medical diagnosis for which an efficacious treatment exists, managed care has resulted in a view of care in terms of a medical model and excludes the many forms of support needed by individuals with chronic conditions. There is also an increased reliance on medications as the sole form of medical care. The debate is whether managed care simply reduces costs (efficiency) or whether it enhances care (effectiveness).
Sociologists have examined managed care constraints on professional autonomy and conflict with bureaucratic control systems. Most of the existent research focuses on physicians and sociologists have found that decisions about clinical care continue to rely upon medical expertise. There needs to be more research on how managed care has affected the work of different groups of health care providers as well as patients. Sociologists also need to focus on ways in which managed care has changed access to health care for different populations. Managed care has the potential to widen access by distributing health care more equitably; it may also restrict access by limiting care to those with acute health care problems and hence neglecting the long term needs of patients with chronic problems, and enhancing inequalities in care.
References:
- Scheid, T. (2004) Tie a Knot and Hang On: Providing Mental Health Care in a Turbulent Environment. Aldine de Gruyter, New York.
- Sullivan, K. (2000) On the efficiency of managed care plans. Health Affairs 19: 139-48.
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