The emergence of the microstatistical paradigm in managed care

Although commentators have argued that managed care constitutes a paradigm shift in the American health care system, it is argued that the guiding organizational assumptions driving orthodox managed care arrangements (i.e., HMOs and capitation) have been drawn from a paradigm that is 300 years old: the business of insurance. As such, traditional managed care directives have taken a macrostatistical organizational viewpoint. However well a macrostatistical paradigmatic view serves certain constructs such as the business of insurance, it is far too coarse a method for organizing and reforming the badly fragmented production processes of health care. As a corrective complement, a new microstatistical paradigmatic view is coming of age whose methodological directives are based in the episode of care, and which will ultimately allow for a more highly refined pricing and care process system to emerge.