MANAGED CARE AND ITS IMPACT ON AMERICAN UROLOGY

America's health care is undergoing a revolution. A previous private, fee-for-service, delivery system chiefly centered around hospital spec ialty care is rapidly being replaced by a commercialized system of man aged care, controlled by businessmen whose prime motive is profit. Inc reasing emphasis of these managed care organizations is upon primary p hysicians who function as gatekeepers. While this new commercialized m ethod of health care has been attended with reductions in the previous omnipresent health care inflation our country has experienced for the past several decades, its impact on quality of care and patient choic e of physician remain a great concern. Especially vulnerable in this n ew system are our nation's academic centers, which, burdened with resp onsibility for education and research, are at a disadvantage in the co mpetitive cost-based bidding for managed care contracts. Urology work force issues and the number of urologists in our nation remain another concern for urologists as they compete for access to patients in this new highly competitive environment. In a 1995 survey of a cohort of u rologists in seven states, the respondents reported 35.8% of gross inc ome came from managed care contracts, 86% reported the need for preser vice approval for many diagnostic and therapeutic undertakings, 87% re ported an inability to refer complex cases outside the Managed Care Or ganization (MCO) network, and 23% reported they were required to retai n patients for treatment who they would have otherwise referred to a m ore qualified urologist, The majority of American urologists are repor ting dropping gross revenues and increasing overhead in their dealings with managed care contracts. The advent of managed care is being atte nded with dropping gross revenues, increasing overhead costs and inter ference with the practice patterns of American urologists. (C) 1998, E lsevier Science Inc. All rights reserved.