Wrestling with typology: Penetrating the "black box" of managed care by focusing on health care system characteristics

The health care system has undergone a fundamental transformation undermini ng the usefulness of the typology of the health maintenance organization, t he independent practice association, the preferred provider organization, a nd so forth. The authors present a new approach to studying the health care system. In matrix form, they have identified a set of organizational and d elivery characteristics with the potential to influence outcomes of interes t, such as access to services, quality, health status and functioning, and cost. The matrix groups the characteristics by domain-financial features, s tructure, rare delivery and management policies, and products-and by key ro les in the health care system-sponsor plan, provider intermediary organizat ion, and direct services provider. The matrix is a tool for researchers, ad ministrators, clinicians, data collectors, regulators, and other policy mak ers. It suggests a new set of players to be studied, emphasizes the relatio nships among the players, and provides a checklist of independent, control, and interactive variables to be included in analyses.