MANAGED CARE

Managed Care

Managed Care

Introdcution

The structure and system of care that are known today as “managed care” trace their history to a series of alternative healthcare arrangements that appeared in various communities across the country as early as the 19th century. The goal of these arrangements was to help meet the healthcare needs of select groups of people, including rural residents and workers and families in the lumber, mining, and railroad industries; the enrollees paid a set fee to physicians who then delivered care under the terms of their agreement. In urban areas, such groups often were paid by benevolent societies to provide care to their members or charges. These prepaid group practices were a model for later entities that came to be known as Health Maintenance Organizations. A frequently cited managed care pioneer is Dr. Michael Shadid, who started a rural farmers' cooperative health plan in Elk City, Oklahoma in 1929. Although he met with significant opposition from other physicians, with help from the Oklahoma Farmers' Union he succeeded in enrolling several hundred families. These members paid a predetermined fee and Dr. Shadid rendered his patient care.

Also in 1929, the Los Angeles Department of Water and Power contracted with Drs. Donald Ross and H. Clifford Loos to provide comprehensive services for about 2,000 workers and their families. Within 5 years, this doctor-owned and controlled group practice prepayment plan at the Ross-Loos Clinic enrolled 12,000 workers plus 25,000 dependents, at a cost of $2.69 per subscriber per month.

In 1933, also in LA, Dr. Sidney Garfield and several associates were providing medical care on a prepaid basis for 5,000 workers on an aqueduct construction project. The workmen's compensation insurance companies paid Garfield a percentage of their premium income to take care of accident cases; the men contributed 5 cents out of their wages for other medical services. Five years later, Garfield did the same for workers at the Grand Coulee Dam for Henry J. Kaiser.

Managed care in the U.S. Health care system

Of the approximately 257.8 million individuals currently living in the United States of America, every one of them has a need for effective, affordable and accessible health care coverage and services. Within the past thirty to forty years, the scope and cost of health care coverage and services has drastically changed, altering the manner in which health care was previously managed. There are several factors that have ...