Education And Debate

Managed care: origins, principles, and evolution

BMJ 1997; 314 doi: (Published 21 June 1997) Cite this as: BMJ 1997;314:1823
  1. Gillian Fairfield, senior registrar in public health medicinea,
  2. David J Hunter, directora,
  3. David Mechanic, René Dubos university professor of behavioural sciencesb,
  4. Flemming Rosleff, chief executivec
  1. a Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL
  2. b Rutgers: The State University of New Jersey at New Brunswick, New Brunswick, NJ 08903, USA
  3. c Bure Managed Care, Box 5419, SE-402 29 Gothenburg, Sweden
  1. Correspondence to: Professor Hunter


    Managed care has entered the lexicon of healthcare reform, but confusion and ignorance surround its meaning and purpose. It seeks to cut the costs of health care while maintaining its quality, but the evidence that it is able to achieve these aims is mixed. As well as raising awareness and understanding of the issues surrounding managed care, this series considers whether managed care is desirable for the NHS. Developed in the United States as a response to spiralling healthcare costs and dysfunctional fragmented services, managed care is not a discrete activity but a spectrum of activities carried out in a range of organisational settings. Due to its constantly changing nature, managed care is a slippery concept–but all its permutations have in common an attempt to influence and modify the behaviour and practice of doctors and other health professionals towards cost effective care. Whatever potential managed care may hold in this regard, careful appraisal of its implications is essential.

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