MANAGING CARE

The terms 'managed care' and 'disease management' are gaining common u sage in the health service but their meaning is not widely understood, Managed care is a generic term describing any health care system that integrates the financing and delivery of medical care, its growth in the United States has been driven by pressure to control costs, and th ere is circumstantial evidence that costs are slowing as a result of b etter management of resources. However, it is not clear how much of th is is due to managed care, the selection of more favourable enrolees t o health plans or other factors, Research evidence is limited, and tha t available is constrained by the rapidly changing nature of managed c are. In the United States a bewildering variety of managed care arrang ements have emerged, although several common characteristics can be id entified: limited choice of physician providers; controlled access to secondary care; selective contracting; financial incentives; quality m anagement; and utilization management. All are present in the National Health Service (NHS), which exemplifies a nationalized managed care s ystem. Disease management is an extension of managed care that takes a global approach to patient care by attempting to co-ordinate resource s across the entire health care delivery system throughout the life cy cle of the disease, This is poorly developed in the NHS, so that the a ttention of commercial organizations has been attracted. However, conc ern has been expressed about the implications of commercial involvemen t: the fragmentation of general medical services; effect of for-profit status; and use of patient-based data. Recent policy developments cou ld allow disease management to develop within the NHS.