US managed care: has the UK anything to learn?

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7162.831 (Published 26 September 1998) Cite this as: BMJ 1998;317:831

Fishbowl medicine is here to stay

  1. Julian Le Grand, Richard Titmuss professor of social policy
  1. London School of Economics, London WC2A 2A

    A few years ago at an international conference the American health economist, Uwe Reinhardt, said that we were all about to enter an era of “fishbowl medicine.” Clinical freedom was disappearing. Clinicians would be increasingly subject to inspection. Instead of exercising their professional judgment about appropriate treatment, they would be required to follow protocols and guidelines and they would be held accountable for their decisions, especially if they departed from those guidelines. A new book by Ray Robinson and Andrea Steiner of Southampton University suggests that Reinhardt was right—at least about the United States.1

    Based on a report prepared for the Department of Health, the book is a systematic review of the US experience of managed care and an analysis of what lessons, if any, the United Kingdom can learn. It paints an extraordinary picture of the US situation. Managed care institutions such as health …

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