Prevention and managed care: the next generation

As we stand at the doorway to the twenty-first century, we are witnessing the restructuring of American health care from a fragmented cottage industry to an actual health care system. This new system is emerging from a foundation of managed care and will be built upon the pillars of prevention. One of the reasons this phenomenon is occurring so rapidly is that capitated managed care shifts to providers the financial risk for the health care needs of an enrolled population. Once providers accept financial risk, it is imperative to assess and manage the medical, health, and economic risks of the enrolled population. Under these incentives, quality-driven, cost-effective care takes on new meaning to physicians. In fact, this new managed care environment begins to merge personal health and public health in such a way that the delivery system will begin to provide personal-based health care from a population-based perspective. Furthermore, the incentives and rewards for maintaining the health of a population will finally be present.