How managed care is reinventing medicaid and other public health-care bureaucracies

The spread of managed rare is rapidly transforming the nation's health rare system. Less well noted, however, is the way this transformation is also r eshaping Medicaid-and other public health-care bureaucracies-across adminis tration internal operations, and policymaking areas. In this article, we ex amine how managed care has contributed to "reinventing government" in such bureaucracies, paying particular attention to shifts in organisational miss ion, competitive contracting, performance measurement; and government regul ation. At the same time, we raise questions about the challenges of capacit y and accountability that arise as public bureaucracies both participate in and respond to the managed rare revolution.