Managed Care in JAMA and the Archives Journals

MANAGEMENT IS the recognition, harnessing, and channeling of all available appropriate forces and resources toward meeting defined goals and objectives. What is "managed" in managed care? How a physician practices, among other things. Managed care is the application of management principles in a comprehensive, prepaid health care delivery system that controls input and output to optimize efficiency and effectiveness with the prior consent of providers and patients. In 1982, 10 million Americans were in managed care; in 1992, 90 million—a megatrend that continues to expand. Victor Cohn of theWashington Postsays, "If you've seen one managed care plan you've seen one managed care plan." The alphabet soup of managed care includes IPA (independent practice association), HMO (health maintenance organization), PPO (preferred provider organization), POS (point-of-service plan), PGP (prepaid group practice), and the beat goes on. The principles and practices of managed care are hardly new. The first group practice in the