ABSTRACT
The year 1994 was one in which it would have been very difficult to find someone who did not believe that America’s health care system needed reforming and who did not support health reform out of fear and compassion. Some feared they might lose their health insurance because of lack of portability or not get it because of preexisting conditions; others supported universal access to health care as a right, especially for the uninsured. Later in 1994, the political stir for health care reform subsided when polls showed that 83% of all insured were content with the quality of their health care and that for Mr. and Mrs. America, crime, the economy, and jobs were higher on the list of concerns. In addition, other polls indicated that 93% of Americans did not want government selecting their physicians, and they further believed health insurance was an obligation of their employers. As a result, in 1995, health care reform is not stirring the political fervor it once caused, although there is movement toward allowing 178states to experiment with reform through Medicaid and Medicare waivers, tort and insurance reform, and new ERISA interpretations. These developments mean that 1995 will be a year in which payers, providers, consumers, and purchasers of health care will continue to be drawn to managed care for its ability to reduce health expenditures while preserving quality. Also in 1995, states will attempt to reform their health insurance acts, medical malpractice acts, health planning processes, provider availability, scope of professional practice, and the pharmaceutical industry’s pricing system. Some of these attempts are misguided and anticompetitive to managed care. But managed care is finding that anticompetitive legislative measures bring new alliances with consumer groups (as happy patients), some state governments (as public purchasers), and some employer groups (as private purchasers) of managed care. While many Americans hoped in 1994 that the federal government would do something about health care costs and access, the health care system has continued down the long road to reform encouraged by favorable marketplace conditions and the Health Maintenance Organization Act of 1973. As more and more Americans enroll in managed health care, five observations can be made. These observations are important to a manufacturer of pharmaceuticals and to any other vendor of health goods and services trying to compete in a system iransforming from indemnity or fee-for-service funding to managed care funding (Figure 1):
Managed care changed health care at a rapid pace while bringing increased competitiveness, documented savings, and improved quality. 1
Managed care is growing in acceptance by Americans, and it is here to stay.
As more people accept managed care as patients, providers, or payers, they relate to each other more positively.
Managed health care is like politics (very local), so if you want to deliver safe, effective, timely health care offering value for the dollar, then effective relationships are needed at the local level.
Managed care relationships are built on a new paradigm of value wherein health care is defined as a service and patients, payers, and providers are empowered as customers.
