MANAGED CARE - IMPLICATIONS OF MANAGED CARE FOR HEALTH SYSTEMS, CLINICIAN, AND PATIENTS

The rhetoric and realities of managed care are easily confused, The ra pid growth of managed care in the United States has had many implicati ons for patients, doctors, employers, state and federal programmes, th e health insurance industry, major medical institutions, medical resea rch, and vulnerable patient populations. It has restricted patients' c hoice of doctors and limited access to specialists, reduced the profes sional autonomy and earnings of doctors, shifted power from the non-pr ofit to the for-profit sectors and from hospitals and doctors to priva te corporations. It has also raised issues about the future structurin g and financing of medical education and research and about practice e thics. However, managed care has also accorded greater prominence to t he assessment of patient satisfaction, profiling and monitoring of doc tors' work, the use of clinical guidelines and quality assurance proce dures and indicated the potential to improve the integration and outco me of care.