How Not to Think About 'Managed Care'
Theodore R. Marmor
Yale School of Management
Jacob S. Hacker
Harvard University - Faculty of Arts and Sciences
University of Michigan Journal of Law Reform, Vol. 32, No. 4, 1999
The premise of this article is that the concept "managed care," like many concepts now prominent in commentary about medical care finance and delivery, is incoherent and thus a barrier to useful analysis. "Managed care," we argue, is a confused assemblage of market sloganeering, aspirational rhetoric, and business school jargon. It presupposes answers to central questions about changes in modern medicine rather than helping to address those questions. To demonstrate this, we first discuss the context in which managed-care claims have arisen and outline the diverse trends to which the category is regularly and confusingly applied. We then suggest an alternative approach to characterizing recent changes in medical care and show how such an approach alters and deepens our understanding of recent economic and political developments. We conclude by arguing for more neutral categories to make sense of past or projected developments in methods of reimbursement and techniques of management.
Date posted: November 16, 1999