Managed Health Care and the Quality of Health Care: A Misguided Debate?
Posted: 1 Apr 2002
As authors note, the growth of managed care has prompted numerous questions about its impact on the quality of health care. After first reviewing some of the evidence on the impacts of managed care on quality, the paper goes on to estimate quality effects using different methods than previously used. The evidence of the existing literature summarized lends one to believe that most comparisons of care for patients in different plans within similar markets suggest that there is little systematic difference in quality between different types of managed care plans and non-managed-care plans. But, the paper argues that the previous empirical literature ignores important effects of managed care on the "structure and functioning of the health care system" that would only be evident across markets. The paper documents evidence for cancer patients showing that across market effects may be important although it is not clear what the exact content of "the structure and functioning of the health care system" to which insight has been gained from the analysis. Lastly, the paper ends with a discussion of how debates about managed care regulation can be conducted better if it considered existing results in the research literature, and suggests ways in which these discussions could be improved. I will divide my comments into two parts that differ in their order from how the paper considered them. First I will argue that the current research debate is misguided and that although the results of the present paper may be interesting, the implications of them seem misguided. My focus will be on the regulatory debate as I and the second discussant, John Crawley, decided to divide up our comments on different aspects of the paper; John focusing on the substantive findings addressed in the first part of the paper and I focusing on the regulatory debate surrounding HMOs addressed in the second part of the paper.
Suggested Citation: Suggested Citation