Impact of managed care organizations on ethnic Americans and underserved populations

Health care reform focuses on cost containment, which in turn focuses on managed care organizations (MCOs). MCOs use strict utilization review and financial risk-shifting to assure that doctors and providers act as gatekeepers to health care services. The gatekeepers are assumed to continue to order necessary care and to eliminate only "unnecessary" care. However, significant potential for abuse exists. In fact, the very foundations on which MCO decisions are made are culturally biased, because they are based on information from largely middle-class, European-American, healthy males. Ultimately, MCOs will change the perceptions and expectations of society regarding health care. These altered perceptions may be contrary to the needs of ethnic Americans, and without safeguards, could worsen existing disparities in health status.