Managed care and the practice of neurology. Implications for neurology residents

The demise of the federal health system reform legislation in 1994 means that the unplanned, market-driven revolution already in motion will proceed unchecked by such social concerns as a requirement to provide health insurance for the 40 million people without health insurance. Managed care has expanded as a market response to spiraling health care costs and has already changed the matrix of health services provision dramatically in some regions. The rapid growth of large for-profit corporations sponsoring managed care plans has displaced nonprofit health maintenance organizations (HMOs) as the dominant force in prepaid group practice. As of 1993, fewer than half of all people with health insurance were covered by traditional indemnity insurance and most observers now expect that not more than 10% of the population will still be covered by unmanaged fee-for-service health insurance in the year 2000, while two thirds of the population will be enrolled in managed care plans with strong physician utilization guidelines.