Managed Care in Transition

Managed care now dominates health care in the United States. By 1999, only 8 percent of persons with employer-sponsored health insurance coverage had traditional indemnity insurance. 1 This reflects a sea change in the past two decades — not just in the financing of health insurance but also in the way medicine is practiced. The rapid growth of managed care is not primarily due to enthusiasm for this approach on the part of patients or providers. Patients have had mixed reactions to managed care; they like the low copayments and reduced paperwork but view some managed-care practices as emphasizing cost control . . .