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Related Experiment Video

Updated: Apr 21, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Managed care: Practice, pitfalls, and potential.

Stanley S Wallack

    Health Care Financing Review
    |November 6, 2014
    PubMed
    Summary
    This summary is machine-generated.

    Managed care can significantly cut health care costs, but savings aren't passed on due to purchaser unawareness. Separating insurance components is key to realizing managed care's full potential.

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    Area of Science:

    • Health Services Research
    • Health Economics
    • Healthcare Management

    Background:

    • Managed care strategies aim to coordinate healthcare services and control costs.
    • Utilization review and case management reduce expensive service use.
    • Provider risk-sharing incentives are crucial for managing healthcare intensity.

    Purpose of the Study:

    • To review the effectiveness of managed care in coordinating and altering healthcare delivery.
    • To identify reasons why managed care cost savings have not reduced overall expenditures or premiums.
    • To propose policy recommendations for optimizing managed care outcomes.

    Main Methods:

    • Review of managed care activities and organizational impacts.
    • Analysis of utilization review and case management program effects.

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  • Examination of provider incentives and their role in cost management.

    • Main Results:

    • Managed care demonstrates a substantial capacity for reducing healthcare costs.
    • Cost efficiencies have not led to lower insurance premiums or moderated total healthcare expenditures.
    • Purchaser awareness and concern for cost-effective care are identified as significant gaps.

    Conclusions:

    • Managed care's potential for cost reduction is significant but currently unrealized.
    • A lack of purchaser engagement with cost-efficiency hinders savings translation.
    • Reforming insurance by separating financing, risk spreading, and program management is proposed to unlock managed care benefits.