The end of managed care

Managed care embodies an effort by employers, the insurance industry, and s ome elements of the medical profession to establish priorities and decide w ho gets what from the health care system. After a turbulent decade of trial and error, that experiment can be characterized as an economic success but a political failure. The strategy of giving with one hand while taking awa y with the other, of offering comprehensive benefits while restricting acce ss through utilization review, has infuriated everyone involved. The protag onists of managed care now are in full retreat, broadening physician panels , removing restrictions, and reverting to fee-for-service payment. Governme ntal entities are avoiding politically volatile initiatives to balance limi ted resources and unlimited expectations, By default, if not by design, the consumer is emerging as the locus of priority setting in health care. The shift to consumerism is driven by a widespread skepticism of governmental, corporate, and professional dominance; unprecedented economic prosperity th at reduces social tolerance for interference with individual autonomy; and the Internet technology revolution, which broadens access to information an d facilitates the mass customization of insurance and delivery.