MANAGED CARE AND THE PUBLIC-HEALTH CHALLENGE OF TB

MANAGED CARE IS FAST becoming the dominant form of medical care. deliv ery and financing in the United States, yet its effects on public heal th practice remain largely unknown. Tuberculosis (TB) is a classic exa mple of a disease with both public health and medical care implication s, and as such it provides an opportunity for examining the impact on public health of the shift towards managed rare in-the medical marketp lace. The authors approach the role of managed care in TB control by f irst considering the need for interorganizational coordination at the community level, The authors identify four basic models of how managed care organizations may fit into TB control efforts in local communiti es, using observations from 12 local public health jurisdictions to il lustrate these models. These TB control models provide insight into th e general mechanisms through which managed care organizations may affe ct other areas of public health practice.