Intended for healthcare professionals


Chronic disease care

BMJ 2004; 328 doi: (Published 22 January 2004) Cite this as: BMJ 2004;328:177
  1. Edward H Wagner, director (
  1. MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1290, Seattle, WA 98101, USA

    Insights from managed care in the United States will help the NHS

    Two papers in this issue of BMJ examine developments in the management of chronic illness in the United States and explore their potential relevance to recent NHS initiatives and policies.1 2 A new King's Fund study of the care of chronically ill people in five leading US managed care organisations, summarised in the paper by Dixon et al (p 220), provides several observations and insights of relevance to new NHS initiatives targeting care of chronic illness.1 The authors conclude that the success of these organisations relates to five factors, which serve as the basis for their recommendations for NHS action. With some minor exceptions, I believe that their observations and recommendations are on target and worthy of serious consideration by policy makers in the United Kingdom.


    The investigators were struck by the intensity of market forces in US health care and although these contributed to variability, excesses, and doctors' discontent, they came away convinced that market forces pushed organisations to improve their quality.3 4 This is debatable. The perceived lack of a compelling business case for …

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