An historical perspective on the roots of managed care

To most people, managed care and managed competition are terms of relatively recent origin, but the concepts are far from new. The use of these terms and their principal predecessors, prepaid group practice and medical care foundations, are symbolic of the underlying problems of the health care systems identified in the United States. With the passage of time, the individuals who first spoke loudly and well on the subject have come and gone, but the central theme of what they had to say was that major changes in the organization, financing, and delivery of health care are absolutely essential if high-quality preventive, diagnostic, and therapeutic care are to be available to the population at an acceptable cost. This paper reviews the early years of recognition of the need for change and the sporadic start of the changes. The presentation leaves out details on the recent growth of managed care and the political turmoil caused by the high level of medical costs, the inadequate documentation of the quality of care, and the large numbers of people who have no insurance or at best inadequate insurance.