Managed care in benign gynecology

Although managed care has been viewed by many as an intrusion into medical practice, the stated goals of its proponents are to improve practice outcomes in a cost-effective manner and change the focus of health care to disease prevention and rational clinical resource utilization. Because health care costs have risen consistently in excess of normal inflation, pressure has mounted to move away from traditional fee-for-service reimbursement and indemnity insurance to capitated payment and 'third party' managed care. Studies have shown that the number of providers of gynecologic care is currently in excess of demand based on a managed-care model. Success in managed care will therefore require an understanding of the new economics of health care and a commitment to the appropriate use of medical and surgical interventions. Research should focus on identifying and reducing the unintended and wasteful variation in practice style that currently exists for benign gynecology and all of health care. Clinical guidelines that are derived from actual measured outcomes and adjusted for severity of illness and co-morbid conditions should replace 'clinical opinion' and allow gynecologists to efficiently manage patients with a minimum of third-party interference.