Economic effects of managed care

There have been substantial changes in the way health care has been paid for in the last half of this century. The original contract between a physician and a patient has evolved to insurance companies paying usual and customary costs for physician services. Now, the medical care of a whole population is bid to organizations willing to insure the risk for managing the care of the population for a prospectively determined fee. The rising cost of health care has imposed new strategies to manage these escalating costs for physician, facilities, and patients. Despite the changes that have radically altered health care delivery, costs continue to rise. This fact ensures that there will be continuing evolution of strategies to decrease the rising rate of health care. Trauma care management traditionally has involved looking at the entire spectrum of the patient's disease process from the prehospital phase to his or her rehabilitation. The discipline that was necessary to identify each component of the system and quantify the cost associated with it has made trauma care a potential model for managed care. There are now systems of care in place that are fully dedicated to trauma. The facilities in them are verified by the American College of Surgeons or a similar professional body. These facilities are designated by a regulatory body, such as the state. It will become more common for payors to require that patients be enrolled in some trauma system of care because this will provide the most cost-effective management, especially for severely injured patients. Surgeons should clearly understand the historic and present strategies for cost-management and how they have evolved. A clear understanding of these forces will allow rational plans to be developed that will deliver the best, most cost effective care to trauma victims.