Evaluating Managed Care Effectiveness

Abstract

Offered to almost everyone who receives employment-based health care benefits, managed care has become the predominant framework for health care plan design. Plan options that emphasize managed care have been added to Medicare and Medicaid programs, making managed care the primary model for health financing and delivery in many parts of the United States. This analysis provides an overview of the functional components of the managed care system. It discusses the market forces underlying the U.S. system for health care financing and delivery and suggests how market forces impact the health care industry. The analysis focuses on societal goals for health care delivery and on managed care's effectiveness in enabling achievement of those goals. This paper develops and uses a descriptive model to summarize the complex interplay among the many stakeholders, or participants, in the health care system. The paper does not propose a quantitative approach to measuring effectiveness; rather, it sets up a model upon which assessments can be made or an index can be developed. The model provides a framework for looking at the many relationships among stakeholders. The discussion also highlights current issues in managed care, particularly the barriers that impede collaboration among stakeholders.