Capitation, integration, and managed care: lessons from early experiments

Article Abstract:

The history of managed care in the US teaches us that any such system should be responsive to the community and should be acceptable to all parties. The first managed health care systems were developed by plantation owners, lumber mill owners and railroads to provide health care to migrant workers in the late 19th Century. The Kaiser Permanente Health Care system originated in California in the 1940s. During the Depression, many physicians and community leaders formed radical new systems involving prepayment, group practice, and salaried physicians. Many of these systems were vigorously opposed by official medical societies. Current managed care proposals must avoid forcing physicians into unacceptable practice parameters. Some states still have laws forbidding physicians to work for anyone but a physician. Many plans may fail just as early experiments failed.

History, Managed care plans (Medical care)

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The compromise and the afterthought: Medicare and Medicaid after 30 years

Article Abstract:

Social Security amendments signed into law in 1965 that created Medicare and Medicaid have substantially changed health care policy. The AMA initially opposed these changes, but beginning about 1970, it supported government-sponsored coverage. Medicaid was set up in a slipshod fashion because it was thought that a large national health insurance program would soon follow. Despite some failures in Medicaid and Medicare, the programs have improved access and decreased health care costs to enrollees and recipients. The programs have continued to grow, but reimbursements have not kept pace with costs. This has encouraged the shifting of costs to privately-insured patients, which caused private health insurance costs to increase. Managed care plans and employer self-insurance plans were designed to control these high costs.

Political aspects, Medicaid, Medicare

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A Concerned Optimist: An Exit Interview With Bruce Vladeck, PhD

Article Abstract:

The former administrator of the US Health Care Financing Administration (HCFA) presents his analysis of the US health care system as it affects elderly Americans. Bruce Vladeck was HCFA's administrator between 1993 and 1997. He believes the agency provided some services to Medicare beneficiaries that had been ignored by previous administrations. The agency redid the Medicare handbook in 1996 and sent it to all beneficiaries for the first time in a decade. It also developed the Health Insurance Counseling Assistance Program, which provides counselors in every state who help Medicare beneficiaries with their insurance questions.

Officials and employees, Interview, United States. Centers for Medicare and Medicaid Services, Vladeck, Bruce C.

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