MANAGED CARE AND PUBLIC-HEALTH DEPARTMENTS - WHO IS RESPONSIBLE FOR THE HEALTH OF THE POPULATION

This review examines changes over the past decade in the delivery of h ealth care in the United States, specifically the move toward managed care and capitation. Over 77 million Americans are now enrolled in hea lth maintenance organizations, and the health care delivery system is reorganizing into large group practices and integrated health systems. Examined here are the implications of this shift on the interaction b etween managed care and public health agencies. How will a population- based system of health care be achieved in light of managed care organ izations' responsibility only far their enrolled population, in contra st to the responsibility of the public health service for the entire p opulation? Where does the responsibility of MCOs end and that of publi c health begin? Should certain public health functions be absorbed by managed care organizations? What are the prospects for partnership bet ween these two systems?