Intended for healthcare professionals

Education And Debate

Managed care: Implications of managed care for health systems, clinicians, and patients

BMJ 1997; 314 doi: (Published 28 June 1997) Cite this as: BMJ 1997;314:1895
  1. Gillian Fairfielda, senior registrar in public health medicine,
  2. J Hunter David, 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


    The rhetoric and realities of managed care are easily confused. The rapid growth of managed care in the United States has had many implications for patients, doctors, employers, state and federal programmes, the health insurance industry, major medical institutions, medical research, and vulnerable patient populations. It has restricted patients' choice of doctors and limited access to specialists, reduced the professional autonomy and earnings of doctors, shifted power from the non-profit to the for-profit sectors and from hospitals and doctors to private corporations. It has also raised issues about the future structuring and financing of medical education and research and about practice ethics. However, managed care has also accorded greater prominence to the assessment of patient satisfaction, profiling and monitoring of doctors' work, the use of clinical guidelines and quality assurance procedures and indicated the potential to improve the integration and outcome of care.

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